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Tephilla E, Elizabeth T, Shalini J, Vinod A. Orthostatic hypotension in the elderly: Prevalence and its management by simple isometric limb tensing exercises. J Family Med Prim Care 2023; 12:2661-2666. [PMID: 38186782 PMCID: PMC10771198 DOI: 10.4103/jfmpc.jfmpc_1009_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/18/2023] [Accepted: 08/09/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Orthostatic hypotension (OH), an important cause of falls in the elderly, is grossly underdiagnosed. Our study aimed to determine the prevalence and associated factors of OH among the elderly attending a secondary care hospital. Furthermore, we assessed and compared the effectiveness of simple arm and leg tensing exercises, performed just prior to standing, to mitigate the orthostatic fall in blood pressure (BP) in elderly OH patients. Materials and Methods A cross-sectional study screened elderly patients (≥65 years) for OH and recruited them into a randomized controlled trial (CTRI/2020/08/027182) of two parallel groups performing either arm tensing or leg tensing exercises just before standing up. We performed an interim analysis of the ongoing trial using paired t-test for within-group comparisons. Patients identified to have OH based on systolic or diastolic fall in BP were analyzed separately. Chi-square analysis compared the improvement in OH status between the two groups. Results Nineteen out of 186 screened elderly patients were diagnosed with OH (10.21%, 95% CI: 7.99-12.43). Arm exercise significantly reduced the orthostatic-induced fall in systolic and diastolic BP, while leg exercise effectively reduced only the systolic fall in BP among patients with OH. The proportion of patients with OH after arm exercise (20%) was significantly lower than after leg exercise (77.8%) (P = 0.023, Fischer's exact test). Conclusion We found a 10.21% prevalence of OH in our elderly population. Furthermore, we found that simple isometric arm tensing exercise ameliorates the fall in BP on standing up in OH patients.
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Affiliation(s)
- Epsibha Tephilla
- Department of Physiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Tharion Elizabeth
- Department of Physiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jeyapaul Shalini
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Abraham Vinod
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
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Jermendy G, Rokszin G, Fábián I, Kempler P, Wittmann I. Morbidity and mortality of patients with diabetic neuropathy treated with pathogenetically oriented alpha-lipoic acid versus symptomatic pharmacotherapies - a nationwide database analysis from Hungary. Diabetes Res Clin Pract 2023:110734. [PMID: 37257759 DOI: 10.1016/j.diabres.2023.110734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/14/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
AIMS Diabetic neuropathy is associated with increased risk of morbidity and all-cause mortality. It is unclear whether these outcomes differ in patients with diabetic neuropathy treated with pathogenetically oriented vs symptomatic pharmacotherapies. METHODS We performed a retrospective (2009-2019) database analysis of patients treated with pathogenetically oriented alpha-lipoic acid (ALA) or symptomatic pharmacotherapies for diabetic neuropathy. We investigated clinical outcomes in propensity score matched patients in Hungary. Changes in hazard ratios and annualized event rates were assessed and sensitivity analyses performed. RESULTS Hazard ratios favored treatment with ALA vs symptomatic pharmacotherapies regarding acute myocardial infarction (HR 0.73, 95%CI: 0.60-0.89, p = 0.0016), stroke (HR 0.71, 95%CI: 0.62-0.82, p<0.0001), hospitalization for heart failure (HR 0.72, 95%CI: 0.66-0.78, p<0.0001), cancer events (HR 0.83, 95% CI: 0.76-0.92, p = 0.0002) and all-cause mortality (HR 0.55, 95% CI: 0.49-0.61, p<0.0001), but not for lower limb amputation (HR 1.05, 95%CI: 0.89-1.25, p = 0.5455). This association was supported by results of evaluating annual event rates and sensitivity analyses. CONCLUSIONS This retrospective database analysis revealed a lower occurrence of cardio- and cerebrovascular morbidity, cancer events and all-cause mortality in patients with diabetic neuropathy treated with pathogenetically oriented ALA vs symptomatic pharmacotherapies. This hypothesis-generating result requires further investigations.
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Affiliation(s)
- György Jermendy
- Bajcsy-Zsilinszky Hospital, 3(rd) Department of Medicine, Maglódi út 89-91, 1106, Budapest, Hungary.
| | - György Rokszin
- RxTarget Ltd., Bacsó Nándor út 10, 5000 Szolnok, Hungary.
| | - Ibolya Fábián
- RxTarget Ltd., Bacsó Nándor út 10, 5000 Szolnok, Hungary.
| | - Péter Kempler
- Semmelweis University, Faculty of Medicine, Department of Medicine and Oncology, Korányi Sándor út 2, 1083 Budapest, Hungary.
| | - István Wittmann
- University of Pécs, Medical School, 2(nd) Department of Medicine, Nephrology-Diabetes Center, Pacsirta út 1, 7624 Pécs, Hungary.
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The Impact of Hypoglycemic Therapy on the Prognosis for Acute Coronary Syndrome in Patients with Type 2 Diabetes. J Pers Med 2022; 12:jpm12050845. [PMID: 35629267 PMCID: PMC9143707 DOI: 10.3390/jpm12050845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023] Open
Abstract
The article discusses particular circumstances of acute coronary syndrome (ACS) in patients with type 2 diabetes (T2D). In addition, the available literature data and clinical guidelines reflecting the role of hypoglycemic therapy as a cardioprotection factor in ACS are analyzed. The article considers possible protective molecular mechanisms of various groups of drugs in ischemic cardiomyocytes.
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Gallego M, Zayas-Arrabal J, Alquiza A, Apellaniz B, Casis O. Electrical Features of the Diabetic Myocardium. Arrhythmic and Cardiovascular Safety Considerations in Diabetes. Front Pharmacol 2021; 12:687256. [PMID: 34305599 PMCID: PMC8295895 DOI: 10.3389/fphar.2021.687256] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022] Open
Abstract
Diabetes is a chronic metabolic disease characterized by hyperglycemia in the absence of treatment. Among the diabetes-associated complications, cardiovascular disease is the major cause of mortality and morbidity in diabetic patients. Diabetes causes a complex myocardial dysfunction, referred as diabetic cardiomyopathy, which even in the absence of other cardiac risk factors results in abnormal diastolic and systolic function. Besides mechanical abnormalities, altered electrical function is another major feature of the diabetic myocardium. Both type 1 and type 2 diabetic patients often show cardiac electrical remodeling, mainly a prolonged ventricular repolarization visible in the electrocardiogram as a lengthening of the QT interval duration. The underlying mechanisms at the cellular level involve alterations on the expression and activity of several cardiac ion channels and their associated regulatory proteins. Consequent changes in sodium, calcium and potassium currents collectively lead to a delay in repolarization that can increase the risk of developing life-threatening ventricular arrhythmias and sudden death. QT duration correlates strongly with the risk of developing torsade de pointes, a form of ventricular tachycardia that can degenerate into ventricular fibrillation. Therefore, QT prolongation is a qualitative marker of proarrhythmic risk, and analysis of ventricular repolarization is therefore required for the approval of new drugs. To that end, the Thorough QT/QTc analysis evaluates QT interval prolongation to assess potential proarrhythmic effects. In addition, since diabetic patients have a higher risk to die from cardiovascular causes than individuals without diabetes, cardiovascular safety of the new antidiabetic drugs must be carefully evaluated in type 2 diabetic patients. These cardiovascular outcome trials reveal that some glucose-lowering drugs actually reduce cardiovascular risk. The mechanism of cardioprotection might involve a reduction of the risk of developing arrhythmia.
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Affiliation(s)
- Mónica Gallego
- Department of Physiology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Julián Zayas-Arrabal
- Department of Physiology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Amaia Alquiza
- Department of Physiology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Beatriz Apellaniz
- Department of Physiology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Oscar Casis
- Department of Physiology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
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Chen J, Cai J, Wei M, Zhang X, Zhong M, Liu M, Yu Y, Chen Q. Effects of Guizhi decoction for diabetic cardiac autonomic neuropathy: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22317. [PMID: 32991439 PMCID: PMC7523786 DOI: 10.1097/md.0000000000022317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Diabetic cardiac autonomic neuropathy (DCAN) is one of the serious complications of diabetes. The pathogenesis of DCAN has not been fully elucidated. There is currently no effective treatment for such chronic disease. Traditional Chinese medicine has a long clinical history for the prevention and treatment of diabetes and chronic complications, and it also shows certain advantages in the treatment of DCAN. Many clinical studies have confirmed that Chinese medicine Guizhi decoction can reduce the clinical symptoms and improve neuronal function of patients with DCAN. So we intend to conduct a systematic review further clarified the effectiveness and safety of Guizhi decoction for DCAN. METHODS We will search each database from the built-in until July 2020. The English literature mainly searches Cochrane Library, PubMed, EMBASE, and Web of Science, while the Chinese literature comes from CNKI, CBM, VIP, and Wangfang database. Simultaneously we will retrieval clinical registration tests and grey literatures. In this study, only the clinical randomized controlled trials (RCTs) were selected to evaluate the efficacy and safety of Guizhi decoction in the treatment of DCAN. The 2 researchers independently conducted literature selection, data extraction, and quality assessment. Statistical heterogeneity among studies will be evaluated using the Cochran Q test (x) and the I statistical value. We will utilize the Review Manage software V5.3.0 (The Nordic Cochrane Center, The Cochrane Collaboration, 2014, Copenhagen, Denmark) to statistically analyze all data. ETHICS AND DISSEMINATION This study is a protocol for a systematic review of Guizhi decoction as a treatment of DCAN patients. RESULTS This study will provide high-quality synthesis of effectiveness and safety of Guizhi decoction for DCAN. CONCLUSION This systematic review aims to provide new options for Guizhi decoction treatment of DCAN in terms of its efficacy and safety. REGISTRATION NUMBER INPLASY202080018.
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Affiliation(s)
- Junmin Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Jiawei Cai
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Mengya Wei
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Xiaoran Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Min Zhong
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Min Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Yang Yu
- College of acupuncture and massage, Chengdu University of Traditional Chinese Medicine , No 37 Shi-er-qiao Road, Chengdu, Sichuan Province, PR China
| | - Qiu Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu
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6
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Gebhard CE, Gebhard C, Maafi F, Bertrand MJ, Stähli BE, Maredziak M, Bengs S, Haider A, Zhang ZW, Smith DC, Ly HQ. Impact of summer season on pre-hospital time delays in women and men undergoing primary percutaneous coronary intervention. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 656:322-330. [PMID: 30513423 DOI: 10.1016/j.scitotenv.2018.11.363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 11/22/2018] [Accepted: 11/24/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Pre-hospital delays have been associated with poor outcomes in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). It is currently unknown how environmental variables affect treatment delays in these patients. METHODS AND RESULTS The association between environmental variables, time to treatment including transportation times and adverse in-hospital events was assessed in 1828 consecutive patients with STEMI undergoing primary PCI between 2010 and 2014 in the Montreal metropolitan area. Median[Q1;Q3] total ischemia time was significantly longer during summer season (April-September) as compared to winter season (October-March, 201[140;305] min vs 187[126;266] min, p = 0.022). This difference between seasons was due to a significant increase in median decision time to seek treatment for symptoms during summer (90[46;185] min vs 78[40;156], p = 0.004). The former peaked during July and August and was most pronounced in men. Hence, outside temperature and summer season were identified as strong predictors of prolonged decision time in patients with STEMI (p < 0.001 and p = 0.002, respectively). Transportation times slightly increased during winter season and snow fall, this difference, however, was not significant (p = 0.46). A significant increase in in-hospital adverse outcomes following primary PCI was observed during summer season as compared to winter season (7.2% vs 4.8%, p = 0.032). Accordingly, multivariate logistic regression models adjusted for baseline variables identified summer season as a strong predictor of periprocedural adverse events (OR 1.83, 95% CI 1.2-3.11, p = 0.037). CONCLUSION Contrary to our initial hypothesis, pre-hospital delays in patients with STEMI are considerably longer and associated with adverse in-hospital outcomes during summer season. Considering the consequences of global warming, it is imperative that educational efforts targeting patients' perception are implemented to counter treatment delays.
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Affiliation(s)
- Caroline E Gebhard
- Montreal Heart Institute, Montreal, Canada; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Catherine Gebhard
- Montreal Heart Institute, Montreal, Canada; Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland.
| | | | | | | | - Monika Maredziak
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | | | | | - Hung Q Ly
- Montreal Heart Institute, Montreal, Canada; Department of Medicine, Université de Montréal, Montreal, Canada
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7
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Didangelos T, Moralidis E, Karlafti E, Tziomalos K, Margaritidis C, Kontoninas Z, Stergiou I, Boulbou M, Papagianni M, Papanastasiou E, Hatzitolios AI. A Comparative Assessment of Cardiovascular Autonomic Reflex Testing and Cardiac 123I-Metaiodobenzylguanidine Imaging in Patients with Type 1 Diabetes Mellitus without Complications or Cardiovascular Risk Factors. Int J Endocrinol 2018; 2018:5607208. [PMID: 29721015 PMCID: PMC5867537 DOI: 10.1155/2018/5607208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/31/2018] [Indexed: 02/08/2023] Open
Abstract
AIM To compare the cardiovascular autonomic reflex tests (CARTs) with cardiac sympathetic innervation imaging with 123I-metaiodobenzylguanidine (MIBG) in patients with type 1 diabetes mellitus (T1DM). PATIENTS AND METHODS Forty-nine patients (29 males, mean age 36 ± 10 years, mean T1DM duration 19 ± 6 years) without cardiovascular risk factors were prospectively enrolled. Participants were evaluated for autonomic dysfunction by assessing the mean circular resultant (MCR), Valsalva maneuver (Vals), postural index (PI), and orthostatic hypotension (OH). Within one month from the performance of these tests, patients underwent cardiac MIBG imaging and the ratio of the heart to upper mediastinum count density (H/M) at 4 hours postinjection was calculated (abnormal values, H/M < 1.80). RESULTS Twenty-nine patients (59%) had abnormal CARTs, and 37 (76%) patients had an H/M_4 < 1.80 (p = 0.456). MCR, PI, Vals, and OH were abnormal in 29 (59%), 8 (16%), 5 (10%), and 11 (22%) patients, respectively. When using H/M_4 < 1.80 as the reference standard, a cutoff point of ≥2 abnormal CARTs had a sensitivity of 100% but a specificity of only 33% for determining CAN. CONCLUSIONS CARTs are not closely associated with 123I-MIBG measurements, which can detect autonomic dysfunction more efficiently than the former. In comparison to semiquantitative cardiac MIBG assessment, the recommended threshold of ≥2 abnormal CARTs to define cardiovascular autonomic dysfunction is highly sensitive but of limited specificity and is independently determined by the duration of T1DM.
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Affiliation(s)
- Triantafyllos Didangelos
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Efstratios Moralidis
- Laboratory of Nuclear Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Eleni Karlafti
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Charalambos Margaritidis
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Zisis Kontoninas
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Ioannis Stergiou
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Maria Boulbou
- Department of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Marianthi Papagianni
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | | | - Apostolos I. Hatzitolios
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Razanskaite-Virbickiene D, Danyte E, Mockeviciene G, Dobrovolskiene R, Verkauskiene R, Zalinkevicius R. Can coefficient of variation of time-domain analysis be valuable for detecting cardiovascular autonomic neuropathy in young patients with type 1 diabetes: a case control study. BMC Cardiovasc Disord 2017; 17:34. [PMID: 28103812 PMCID: PMC5244586 DOI: 10.1186/s12872-016-0467-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 12/29/2016] [Indexed: 02/07/2023] Open
Abstract
Background Cardiovascular autonomic neuropathy (CAN) increases morbidity and mortality in diabetes through association with a high risk of cardiac arrhythmias and sudden death, possibly related to silent myocardial ischemia. During the sub-clinical stage, CAN can be detected through reduction in heart rate variability (HRV). The aim of our study was to estimate if the time and frequency-domain analysis can be valuable for detecting CAN in young patients with type 1 diabetes mellitus (T1DM). Methods For this case control study of evaluation of cardiovascular autonomic function the 15–25 years age group of patients with duration of T1DM more than 9 years (n = 208, 89 males and 119 females) were selected. 67 patients with confirmed CAN were assigned to the “case group” and 141 patients without CAN served as a control group, the duration of T1DM was similar (15.07 ± 4.89 years vs.13.66 ± 4.02 years; p = 0.06) in both groups. Cardiovascular autonomic reflex tests and time and frequency domains analysis of HRV were performed for all subjects. Results Time domain measures were significantly lower in CAN group compared with control (p < 0.05). R-R max / R-R min ratio and coefficient of variation (CV) were the lowest during deep breathing among T1DM patients with CAN. Receivers operating characteristic (ROC) curves were constructed to compare the accuracies of the parameters of time-domain analysis for diagnosing CAN. We estimated a more reliable cut-off value of parameters of time-domain. The CV values in supine position <1.65, reflected sensitivity 94.3%, specificity 91.5%. The CV values during deep breathing <1.45 reflected sensitivity 97.3%, specificity 96.2%. The CV values in standing position <1.50 reflected sensitivity 96.2%, specificity 93.0%. The most valuable CV was during deep breathing (AUC 0.899). The results of frequency-domain (spectral analysis) analysis showed significant decrease in LF power and LFPA, HF Power and HFPA, total power among subjects with CAN than compared with subjects without CAN (p < 0.05). Conclusions Time and frequency domain analysis of HRV permits a more accurate evaluation of cardiovascular autonomic function, providing more information about sympathetic and parasympathetic activity. The coefficient of variation (time-domain analysis) especially during deep breathing could be valuable for detecting CAN.
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Affiliation(s)
| | - Evalda Danyte
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-44307, Kaunas, Lithuania
| | - Giedre Mockeviciene
- Department of Endocrinology Medical Academy, Lithuanian University of Health Sciences, LT-44307, Kaunas, Lithuania
| | - Rimante Dobrovolskiene
- Department of Endocrinology Medical Academy, Lithuanian University of Health Sciences, LT-44307, Kaunas, Lithuania
| | - Rasa Verkauskiene
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-44307, Kaunas, Lithuania
| | - Rimantas Zalinkevicius
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-44307, Kaunas, Lithuania
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Victor de Sousa C, Sales MM, Aguiar SDS, Boullosa DA, Rosa TDS, Baldissera V, Simões HG. Double product break point estimates ventilatory threshold in individuals with type 2 diabetes. J Phys Ther Sci 2016; 28:1775-80. [PMID: 27390414 PMCID: PMC4932055 DOI: 10.1589/jpts.28.1775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/28/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To verify the identification of the anaerobic threshold through the double product breakpoint (DPBP) method for individuals with type 2 diabetes. [Subjects and Methods] Nine individuals with T2D (7 females; age=63.2 ± 8.9 y) and 10 non-diabetic (ND) (7 females; age=58.3 ± 7.8 y) performed an incremental exercise test on a cycle ergometer. Heart rate (HR), blood pressure (BP) and expired gas were measured at the end of each stage. The ventilatory threshold (VT) and DPBP were considered as the exercise intensities above which an over proportional increases in VE and DP were observed in relation to increasing workload. [Results] No differences were observed between the workloads, HR and VO2 corresponding to the AT identified respectively by VT and DPBP. For the T2D, strong correlations between VT and DBPB workloads (r=0.853), HR (r=0.714), and VO2 (r=0.863) were found. These relationships were similar to those found for the control group (r=0.923; r=0.881; and r=0.863, respectively). [Conclusion] These results demonstrate that the DPBP enables for the prediction of AT and correlated well the VT in both the T2D and ND participants.
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Affiliation(s)
- Caio Victor de Sousa
- Graduate Program on Physical Education, Universidade Católica de Brasília-UCB, Brazil
| | - Marcelo Magalhães Sales
- Graduate Program on Physical Education, Universidade Católica de Brasília-UCB, Brazil; Health School, UDF -Centro Universitário, Brazil
| | | | | | | | - Vilmar Baldissera
- Faculty of Physical Education, Universidade Federal de São Carlos, Brazil
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10
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Lewis JE, Lantigua L, Atlas SE, Lopez J, Mendez A, Goldberg S, Medici S, Konefal J, Woolger JM, Tiozzo E, Aliffe KH. A cross-sectional assessment to detect type 2 diabetes with endothelial and autonomic nervous system markers using a novel system. J Diabetes Metab Disord 2014; 13:118. [PMID: 25530952 PMCID: PMC4271477 DOI: 10.1186/s40200-014-0118-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/01/2014] [Indexed: 12/27/2022]
Abstract
Background Type 2 diabetes mellitus is frequently unrecognized until complications appear. Diabetic autonomic neuropathy is one of the early complications of type 2 diabetes mellitus, resulting in autonomic nervous system (ANS) dysfunction. The purpose of this study was to determine the validity of ANS function indicators to screen for type 2 diabetes mellitus, as measured by the TM-Oxi and SudoPath system. Methods All enrolled participants completed a basic sociodemographic and medical history questionnaire including current medications. Healthy controls (n = 25) underwent a 2-hour oral glucose tolerance test (OGTT) to evaluate glucose, insulin, and insulin C-peptide. Patients with type 2 diabetes mellitus (n = 24) were assessed with fasting plasma glucose (FPG) and glycosylated hemoglobin. The TM-Oxi and SudoPath system evaluation was completed by all subjects. Data were analyzed using SPSS 22. Frequency and descriptive statistics were calculated on all variables. The criterion for statistical significance was α = 0.05. Results The twenty-five healthy controls had a mean age of 37.0 years. The twenty-four type 2 diabetes mellitus patients currently undergoing standard treatment had a mean age of 48.9 years. Based on the American Diabetes Association guidelines, we detected pre-diabetes in 4 subjects and diabetes in 1 subject, while all other subjects had normal FPG values. At 120 minutes, the correlations between the OGTT and cardiometabolic risk score (CMRS) were: r = 0.56 (p = 0.004) for glucose and r = 0.53 (p = 0.006) for insulin. At 120 minutes, the correlations between the OGTT and photoplethysmography index (PTGi) were: r = -0.56 (p = 0.003) for glucose and r = -0.41 (p = 0.04) for insulin. The CMRS, PTGi, and plethysmography total power index (PTGVLFi) differed significantly between the diabetes patients and healthy participants. The specificity and sensitivity for the CMRS, PTGi, and PTVLFi comparing the diabetes patients with healthy controls were high. Conclusion The TM-Oxi and SudoPath system shows promise as a valid, convenient, and non-invasive screening method for type 2 diabetes mellitus. The ANS function and CMR indicators measured by this system may be useful in guiding diabetes and cardiovascular health screening, treatment, and monitoring.
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Affiliation(s)
- John E Lewis
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite #1474 (D28), Miami, FL 33136 USA
| | - Laura Lantigua
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite #1474 (D28), Miami, FL 33136 USA
| | - Steven E Atlas
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite #1474 (D28), Miami, FL 33136 USA
| | - Johanna Lopez
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite #1474 (D28), Miami, FL 33136 USA
| | - Armando Mendez
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136 USA
| | - Sharon Goldberg
- Division of Hospital Medicine, University of Miami Miller School of Medicine, Miami, FL 33136 USA
| | - Sacha Medici
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite #1474 (D28), Miami, FL 33136 USA
| | - Janet Konefal
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite #1474 (D28), Miami, FL 33136 USA
| | - Judi M Woolger
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136 USA
| | - Eduard Tiozzo
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite #1474 (D28), Miami, FL 33136 USA
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11
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Sun HJ, Zhou H, Feng XM, Gao Q, Ding L, Tang CS, Zhu GQ, Zhou YB. Superoxide anions in the paraventricular nucleus mediate cardiac sympathetic afferent reflex in insulin resistance rats. Acta Physiol (Oxf) 2014; 212:267-82. [PMID: 25307720 DOI: 10.1111/apha.12405] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 05/26/2014] [Accepted: 10/06/2014] [Indexed: 12/14/2022]
Abstract
AIM Cardiac sympathetic afferent reflex (CSAR) participates in sympathetic over-excitation. Superoxide anions and angiotensin II (Ang II) mechanisms are associated with sympathetic outflow and CSAR in the paraventricular nucleus (PVN). This study was designed to investigate whether PVN superoxide anions mediate CSAR and Ang II-induced CSAR enhancement response in fructose-induced insulin resistance (IR) rats. METHODS CSAR was evaluated with the changes of renal sympathetic nerve activity (RSNA) and mean arterial pressure (MAP) responses to the epicardial application of capsaicin (CAP) in anaesthetized rats. RESULTS Compared with Control rats, IR rats showed that CSAR, PVN NAD(P)H oxidase activity, superoxide anions, malondialdehyde (MDA), Ang II and AT1 receptor levels were significantly increased, whereas PVN superoxide dismutase (SOD) and catalase (CAT) activities were decreased. In Control and IR rats, PVN microinjection of superoxide anions scavengers tempol, tiron and PEG-SOD (an analogue of endogenous superoxide dismutase) or inhibition of PVN NAD(P)H oxidase with apocynin caused significant reduction of CSAR, respectively, but DETC (a superoxide dismutase inhibitor) strengthened the CSAR. PVN pre-treatment with tempol abolished, whereas DETC potentiated, Ang II-induced CSAR enhancement response. Moreover, PVN pre-treatment with tempol or losartan prevented superoxide anions increase caused by Ang II in IR rats. CONCLUSION PVN superoxide anions mediate CSAR and Ang II-induced CSAR response in IR rats. In IR state, increased NAD(P)H oxidase activity and decreased SOD and CAT activities in the PVN promote superoxide anions increase to involve in CSAR enhancement. Ang II may increase NAD(P)H oxidase activity via AT1 receptor to induce superoxide anion production.
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Affiliation(s)
- H.-J. Sun
- Key Laboratory of Cardiovascular Disease and Molecular Intervention; Department of Physiology; Nanjing Medical University; Nanjing China
| | - H. Zhou
- Laboratory Center for Basic Medical Sciences; Nanjing Medical University; Nanjing China
| | - X.-M. Feng
- Clinical Laboratory of Luyi Xian People's Hospital; Zhoukou China
| | - Q. Gao
- Laboratory Center for Basic Medical Sciences; Nanjing Medical University; Nanjing China
| | - L. Ding
- Key Laboratory of Cardiovascular Disease and Molecular Intervention; Department of Physiology; Nanjing Medical University; Nanjing China
| | - C.-S. Tang
- Key Laboratory of Molecular Cardiovascular Science; Ministry of Education; Beijing China
| | - G.-Q. Zhu
- Key Laboratory of Cardiovascular Disease and Molecular Intervention; Department of Physiology; Nanjing Medical University; Nanjing China
| | - Y.-B. Zhou
- Key Laboratory of Cardiovascular Disease and Molecular Intervention; Department of Physiology; Nanjing Medical University; Nanjing China
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12
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Malfitano C, Barboza CA, Mostarda C, da Palma RK, dos Santos CP, Rodrigues B, Freitas SCF, Belló-Klein A, Llesuy S, Irigoyen MC, De Angelis K. Diabetic hyperglycemia attenuates sympathetic dysfunction and oxidative stress after myocardial infarction in rats. Cardiovasc Diabetol 2014; 13:131. [PMID: 25301475 PMCID: PMC4198704 DOI: 10.1186/s12933-014-0131-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/29/2014] [Indexed: 12/29/2022] Open
Abstract
Background Previous research has demonstrated that hyperglycemia may protect the heart against ischemic injury. The aim of the present study was to investigate the association between hyperglycemia and myocardial infarction on cardiovascular autonomic modulation and cardiac oxidative stress profile in rats. Male Wistar rats were divided into: control (C), diabetic (D), myocardial infarcted (MI) and diabetic infarcted rats (DMI). Methods Diabetes was induced by streptozotocin (STZ, 50 mg/Kg) at the beginning of the protocol and MI was induced by left coronary occlusion 15 days after STZ. Thirty days after streptozocin-induced diabetes, cardiovascular autonomic modulation was evaluated by spectral analysis, and oxidative stress profile was determined by antioxidant enzyme activities and superoxide anion, together with protein carbonylation and redox balance of glutathione (GSH/GSSG). Results The diabetic and infarcted groups showed decreased heart rate variability and vagal modulation (p < 0.05); however, sympathetic modulation decreased only in diabetic groups (p < 0.05). Sympatho/vagal balance and vascular sympathetic modulation were increased only in the MI group (p < 0.05). Diabetes promoted an increase in catalase concentration (p < 0.05). Glutathione peroxidase activity was increased only in DMI when compared to the other groups (p < 0.05). Superoxide anion and protein carbonylation were increased only in MI group (p < 0.05). Cardiac redox balance, as evaluated by GSH/GSSG, was lower in the MI group (p < 0.05). Conclusions These data suggest that hyperglycemia promotes compensatory mechanisms that may offer protection against ischemia, as demonstrated by increased antioxidants, decreased pro-oxidants and protein damage, possibly related to the improvements in both redox balance and sympathetic modulation to the heart.
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13
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Cruz JPS. Recurrent Right Ventricular Takotsubo Syndrome in a Diabetic Patient With Dysautonomia: Response. Chest 2014; 146:e73-4. [DOI: 10.1378/chest.14-0909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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14
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Wang G. Effects of impaired glucose metabolism on heart rate variability and blood pressure variability in essential hypertension patients. ACTA ACUST UNITED AC 2014; 26:654-6. [PMID: 17357480 DOI: 10.1007/s11596-006-0606-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To investigate the effects of impaired glucose metabolism (IGM) on cardiovascular autonomic nervous systems in essential hypertensive (EH) patients by comparing heart rate variability (HRV) and blood pressure variability (BPV) in EH patients with or without type 2 diabetes mellitus (T2DM). Simultaneous 24-h recordings of ambulatory ECG and blood pressure monitoring were performed in 36 male old patients with simple EH and 33 male old patients with EH combined with T2DM. HRV analysis included time domain parameters such as SDNN, SDANN, SDNNi, rMSSD and pNN50, and total spectral power (TP) of HRV, which mainly consists of VLF, LF and HF component along with LF/HF ratio, was also obtained. The value of ambulatory blood pressure was represented as the mean blood pressure (mean systolic/mSBP, diastolic/mDBP and pulse pressure/mPP) during different periods (24 h/24 h, day time/d and night time/n). Standard deviation (SD) as well as coefficient of variance (CV) of blood pressure during each above-mentioned period were obtained to reflect the long-term BPV. Our result showed that SDNN, SDNNi, SDANN, rMSSD, PNN50, TP and HF of HRV in cases of EH with T2DM were all significantly lower than those in simple EH subjects (P<0.05). No significant differences in VLF or LF was found between the two groups (P>0.05), while LF/HF ratio was significantly higher in EH with T2DM patients than in simple EH subjects (P<0.01). Moreover, dmSBP, 24 h-mPP and dmPP were all significantly higher in EH with T2DM patients than in simple EH subjects (P<0.05), while nmSBP, 24 h-mSBP, 24 h-mDBP, dmDBP, nmDBP or nmPP showed no significant difference between this two groups of patients (P>0.05). And dSBPSD, dSBPCV and 24 h-SBPSD were all significantly higher in EH with T2DM patients than in simple EH subjects (P<0.05), while the other BPV indexes showed no significant difference between this two groups (P>0.05). It is concluded that the cardiovascular autonomic nervous systems in EH patients was further impaired by T2DM, displaying lowering of HRV and enlargement of BPV, which in turn induced abnormal structural and functional changes of cardiovascular systems. Therefore, improving cardiovascular autonomic nervous systems might reduce the occurrence of cardiovascular complications in the EH patients with IGM.
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Affiliation(s)
- Gang Wang
- Department of Gerontology,General Hospital of Guangzhou Military Command, Guangzhou 510010, China
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15
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Xue M, Xuan YL, Wang Y, Hu HS, Li XL, Suo F, Li XR, Cheng WJ, Yan SH. Exogenous nerve growth factor promotes the repair of cardiac sympathetic heterogeneity and electrophysiological instability in diabetic rats. Cardiology 2013; 127:155-63. [PMID: 24356397 DOI: 10.1159/000355535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 09/07/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Diabetic cardiac autonomic neuropathy can lead to an increased incidence of ventricular arrhythmias (VAs). However, few data are available regarding the pathogenesis and therapy of the VAs accompanying diabetic cardiac autonomic neuropathy. We aimed to explore whether or not exogenous nerve growth factor (NGF) can reduce the sympathetic heterogeneity and the incidence of VAs in diabetes mellitus (DM). METHODS Male Wistar rats were randomly divided into 3 groups: controls, rats with DM with saline infused into the left stellate ganglion (LSG), i.e. the DS group and rats with DM with NGF infused into the LSG, i.e. the DN group. After 28 weeks, all rats were subjected to electrophysiological experiments. Sympathetic innervations and NGF were studied by immunostaining, RT-PCR or Western blot analysis. RESULTS The incidence of inducible VAs was significantly higher in the DS group than in the control group, but was markedly decreased in the DN group. In the DS group, the tyrosine hydroxylase (TH) and NGF expression were significantly lower than in the other groups, and significant proximal-distal heterogeneities existed regarding the TH and NGF expression in the left ventricle, but were markedly repaired in the DN group. CONCLUSIONS NGF intervention in the LSG can reduce the heterogeneity of cardiac sympathetic innervations and the incidence of VAs in diabetic rats.
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Affiliation(s)
- Mei Xue
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, P.R. China
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Simões HG, Asano RY, Sales MM, Browne RAV, Arsa G, Motta-Santos D, Puga GM, Lima LCDJ, Campbell CSG, Franco OL. Type 2 diabetes elicits lower nitric oxide, bradykinin concentration and kallikrein activity together with higher DesArg(9)-BK and reduced post-exercise hypotension compared to non-diabetic condition. PLoS One 2013; 8:e80348. [PMID: 24265812 PMCID: PMC3827199 DOI: 10.1371/journal.pone.0080348] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/01/2013] [Indexed: 02/07/2023] Open
Abstract
This study compared the plasma kallikrein activity (PKA), bradykinin concentration (BK), DesArg(9)-BK production, nitric oxide release (NO) and blood pressure (BP) response after moderate-intensity aerobic exercise performed by individuals with and without type 2 diabetes. Ten subjects with type 2 diabetes (T2D) and 10 without type 2 diabetes (ND) underwent three sessions: 1) maximal incremental test on cycle ergometer to determine lactate threshold (LT); 2) 20-min of constant-load exercise on cycle ergometer, at 90% LT and; 3) control session. BP and oxygen uptake were measured at rest and at 15, 30 and 45 min post-exercise. Venous blood samples were collected at 15 and 45 minutes of the recovery period for further analysis of PKA, BK and DesArg(9)-BK. Nitrite plus nitrate (NOx) was analyzed at 15 minutes post exercise. The ND group presented post-exercise hypotension (PEH) of systolic blood pressure and mean arterial pressure on the 90% LT session but T2D group did not. Plasma NOx increased ~24.4% for ND and ~13.8% for T2D group 15 min after the exercise session. Additionally, only ND individuals showed increases in PKA and BK in response to exercise and only T2D group showed increased DesArg(9)-BK production. It was concluded that T2D individuals presented lower PKA, BK and NOx release as well as higher DesArg(9)-BK production and reduced PEH in relation to ND participants after a single exercise session.
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Affiliation(s)
- Herbert Gustavo Simões
- Programa de Pós-Graduação em Educação Física, Universidade Católica de Brasília, Brasília, DF, Brasil
- Centro de Análises Proteômicas e Bioquímicas, Universidade Católica de Brasília, Brasília, DF, Brasil
- Programa de Pós-Graduação em Imunologia e DIP/ Genética e Biotecnologia, Universidade Federal de Juiz de Fora, Minas Gerais, Brasil
- * E-mail:
| | - Ricardo Yukio Asano
- Programa de Pós-Graduação em Educação Física, Universidade Católica de Brasília, Brasília, DF, Brasil
| | - Marcelo Magalhães Sales
- Programa de Pós-Graduação em Educação Física, Universidade Católica de Brasília, Brasília, DF, Brasil
| | | | - Gisela Arsa
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Mato Grosso, Cuiabá, Mato Grosso, Brasil
| | - Daisy Motta-Santos
- Departamento de Fisiologia and Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Guilherme Morais Puga
- Departamento de Educação Física, UNESP, Rio Claro, SP, Brasil
- Departamento de Educação Física, UFU, Uberlândia, Minas Gerais, Brasil
| | | | | | - Octavio Luiz Franco
- Programa de Pós-Graduação em Educação Física, Universidade Católica de Brasília, Brasília, DF, Brasil
- Centro de Análises Proteômicas e Bioquímicas, Universidade Católica de Brasília, Brasília, DF, Brasil
- Programa de Pós-Graduação em Imunologia e DIP/ Genética e Biotecnologia, Universidade Federal de Juiz de Fora, Minas Gerais, Brasil
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Ganesha S, Thirthalli J, Muralidharan K, Benegal V, Gangadhar BN. Heart rate variability during sleep in detoxified alcohol-dependent males: A comparison with healthy controls. Indian J Psychiatry 2013; 55:173-7. [PMID: 23825854 PMCID: PMC3696243 DOI: 10.4103/0019-5545.111458] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
CONTEXT Alcohol dependence can lead to autonomic neuropathy resulting in increased cardiac morbidity and mortality. This has previously been evaluated using heart-rate variability. AIMS We compared sleep heart-rate variability of alcohol-dependent patients with that of healthy controls in this study. SETTINGS AND DESIGN This study was conducted at NIMHANS, Bangalore. A case control study design was adopted. MATERIALS AND METHODS Sleep heart-rate variability of 20 male alcohol-dependent inpatients was recorded on the 5(th) day after detoxification. Sleep heart-rate variability was also recorded in 18 age- and gender-matched healthy controls. STATISTICAL ANALYSIS The groups were compared using t-test for continuous variables and Chi-squared test for discrete variables. RESULTS Both time and frequency domain measures were significantly lower in the patients as compared to the controls, indicating decreased HRV in alcohol-dependent individuals. CONCLUSIONS Decreased HRV in alcohol dependence indicates potential autonomic neuropathy.
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Affiliation(s)
- Suhas Ganesha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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18
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ROSENHECK SHIMON. Sympathetic Dysinnervation, QT Variability and the Limitations of Statistical Work-Up. J Cardiovasc Electrophysiol 2012; 24:314-5. [DOI: 10.1111/jce.12055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Junqueira LF. Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease. Rev Soc Bras Med Trop 2012; 45:243-52. [PMID: 22535000 DOI: 10.1590/s0037-86822012000200020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 01/10/2012] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Exclusive or associated lesions in various structures of the autonomic nervous system occur in the chronic forms of Chagas disease. In the indeterminate form, the lesions are absent or mild, whereas in the exclusive or combined heart and digestive disease forms, they are often more pronounced. Depending on their severity these lesions can result mainly in cardiac parasympathetic dysfunction but also in sympathetic dysfunction of variable degrees. Despite the key autonomic effect on cardiovascular functioning, the pathophysiological and clinical significance of the cardiac autonomic dysfunction in Chagas disease remains unknown. METHODS Review of data on the cardiac autonomic dysfunction in Chagas disease and their potential consequences, and considerations supporting the possible relationship between this disturbance and general or cardiovascular clinical and functional adverse outcomes. RESULTS We hypothesise that possible consequences that cardiac dysautonomia might variably occasion or predispose in Chagas disease include: transient or sustained arrhythmias, sudden cardiac death, adverse overall and cardiovascular prognosis with enhanced morbidity and mortality, an inability of the cardiovascular system to adjust to functional demands and/or respond to internal or external stimuli by adjusting heart rate and other hemodynamic variables, and immunomodulatory and cognitive disturbances. CONCLUSIONS Impaired cardiac autonomic modulation in Chagas disease might not be a mere epiphenomenon without significance. Indirect evidences point for a likely important role of this alteration as a primary predisposing or triggering cause or mediator favouring the development of subtle or evident secondary cardiovascular functional disturbances and clinical consequences, and influencing adverse outcomes.
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Affiliation(s)
- Luiz Fernando Junqueira
- Laboratório Cardiovascular, Área de Clínica Médica (Cardiologia), Universidade de Brasilia, Brasilia, DF.
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20
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Zhang L, Xiong XQ, Fan ZD, Gan XB, Gao XY, Zhu GQ. Involvement of enhanced cardiac sympathetic afferent reflex in sympathetic activation in early stage of diabetes. J Appl Physiol (1985) 2012; 113:47-55. [DOI: 10.1152/japplphysiol.01228.2011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cardiac sympathetic afferent reflex (CSAR) is involved in sympathetic activation. The present study was designed to investigate the contribution of enhanced CSAR to sympathetic activation in the early stage of diabetes and the involvement of AT1 receptors in the paraventricular nucleus (PVN). Diabetes was induced by a single intravenous injection of streptozotocin in rats. Acute experiments were carried out under anesthesia after 3 wk. The CSAR was evaluated by the responses of renal sympathetic nerve activity (RSNA) and mean arterial pressure (MAP) to epicardial application of capsaicin or bradykinin. Sympathetic activity and CSAR were enhanced in diabetic rats. Plasma norepinephrine and angiotensin II were increased, but the transient receptor potential vanilloid 1 (TRPV1) in the left ventricle wall was not significantly increased in diabetic rats. Pericardial injection of resiniferatoxin to desensitize cardiac afferents or PVN microinjection of lidocaine attenuated the CSAR and decreased the RSNA and MAP in diabetic rats. The AT1 receptor expression in the PVN increased in diabetic rats. Angiotensin II in the PVN caused greater increases in the RSNA and MAP and enhancement in the CSAR in diabetic rats, which were abolished by the losartan pretreatment. Losartan decreased the RSNA and MAP and attenuated the CSAR in diabetic rats but not in control rats. These results indicate that the CSAR is enhanced in the early stage of diabetic rats, which contributes to the sympathetic activation. AT1 receptors in the PVN are involved in the enhanced CSAR in diabetic rats.
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Affiliation(s)
- Lei Zhang
- Key Laboratory of Cardiovascular Disease and Molecular Intervention, Department of Physiology, Nanjing Medical University, Nanjing; and
| | - Xiao-Qing Xiong
- Key Laboratory of Cardiovascular Disease and Molecular Intervention, Department of Physiology, Nanjing Medical University, Nanjing; and
| | - Zhi-Dan Fan
- Department of Rheumatology and Immunology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Xian-Bing Gan
- Key Laboratory of Cardiovascular Disease and Molecular Intervention, Department of Physiology, Nanjing Medical University, Nanjing; and
| | - Xing-Ya Gao
- Key Laboratory of Cardiovascular Disease and Molecular Intervention, Department of Physiology, Nanjing Medical University, Nanjing; and
| | - Guo-Qing Zhu
- Key Laboratory of Cardiovascular Disease and Molecular Intervention, Department of Physiology, Nanjing Medical University, Nanjing; and
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21
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A clinical score to predict survival from hyperglycemic crisis following general medical wards admission in a resource constrained setting. Int J Diabetes Dev Ctries 2012. [DOI: 10.1007/s13410-012-0064-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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22
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Osztovits J, Horváth T, Littvay L, Steinbach R, Jermendy A, Tárnoki A, Tárnoki D, Métneki J, Kollai M, Jermendy G. Effects of genetic vs. environmental factors on cardiovascular autonomic function: a twin study. Diabet Med 2011; 28:1241-8. [PMID: 21679234 DOI: 10.1111/j.1464-5491.2011.03363.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS Cardiovascular autonomic function is often assessed in patients with diabetes by measuring heart rate variability and baroreflex sensitivity, the heritability of which is not fully understood. The present study was aimed to determine the effects of genetic and environmental factors on heart rate variability and baroreflex sensitivity in monozygotic and dizygotic adult healthy twin pairs. METHODS A total of 101 (63 monozygotic, 38 dizygotic) adult twin pairs (n = 202; mean age 44.3 years) were investigated. Anthropometric variables and serum metabolic markers were measured, while environmental characteristics were evaluated by questionnaires. Linear and spectral indices of heart rate variability and baroreflex sensitivity were determined by non-invasive methods. All measurements were adjusted for age and gender (model 1) and for all significantly relevant covariates (model 2). Heritability A-C-E structural equation models were used for characterizing the proportion of additive genetic, shared and unshared environmental influences. RESULTS Genetic influence of different cardiovascular autonomic indices was estimated between 10.3 and 39.4%, common environmental influence was found between 0.0 and 33.2%, while unshared environmental influence was observed between 60.6 and 81.4% in model 1 analysis. In multivariable-adjusted heritability estimates (model 2), the magnitude of the genetic effects decreased to 0.0%, common environmental influence was nearly unchanged (values between 4.4 and 14.5%), while unshared environmental influence slightly increased (values between 85.5 and 96.5%). CONCLUSIONS Unshared environmental but not genetic factors have substantial influence on cardiovascular autonomic function, suggesting that appropriate treatment of all modifiable environmental factors is of importance in order to prevent or ameliorate cardiovascular autonomic neuropathy.
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Affiliation(s)
- J Osztovits
- Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
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Sales MM, Campbell CSG, Morais PK, Ernesto C, Soares-Caldeira LF, Russo P, Motta DF, Moreira SR, Nakamura FY, Simões HG. Noninvasive method to estimate anaerobic threshold in individuals with type 2 diabetes. Diabetol Metab Syndr 2011; 3:1. [PMID: 21226946 PMCID: PMC3033241 DOI: 10.1186/1758-5996-3-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 01/12/2011] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND While several studies have identified the anaerobic threshold (AT) through the responses of blood lactate, ventilation and blood glucose others have suggested the response of the heart rate variability (HRV) as a method to identify the AT in young healthy individuals. However, the validity of HRV in estimating the lactate threshold (LT) and ventilatory threshold (VT) for individuals with type 2 diabetes (T2D) has not been investigated yet. AIM To analyze the possibility of identifying the heart rate variability threshold (HRVT) by considering the responses of parasympathetic indicators during incremental exercise test in type 2 diabetics subjects (T2D) and non diabetics individuals (ND). METHODS Nine T2D (55.6 ± 5.7 years, 83.4 ± 26.6 kg, 30.9 ± 5.2 kg.m2(-1)) and ten ND (50.8 ± 5.1 years, 76.2 ± 14.3 kg, 26.5 ± 3.8 kg.m2(-1)) underwent to an incremental exercise test (IT) on a cycle ergometer. Heart rate (HR), rate of perceived exertion (RPE), blood lactate and expired gas concentrations were measured at the end of each stage. HRVT was identified through the responses of root mean square successive difference between adjacent R-R intervals (RMSSD) and standard deviation of instantaneous beat-to-beat R-R interval variability (SD1) by considering the last 60 s of each incremental stage, and were known as HRVT by RMSSD and SD1 (HRVT-RMSSD and HRVT-SD1), respectively. RESULTS No differences were observed within groups for the exercise intensities corresponding to LT, VT, HRVT-RMSSD and HHVT-SD1. Furthermore, a strong relationship were verified among the studied parameters both for T2D (r = 0.68 to 0.87) and ND (r = 0.91 to 0.98) and the Bland & Altman technique confirmed the agreement among them. CONCLUSION The HRVT identification by the proposed autonomic indicators (SD1 and RMSSD) were demonstrated to be valid to estimate the LT and VT for both T2D and ND.
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Affiliation(s)
- Marcelo M Sales
- Graduate program in Physical Education of the Catholic University of Brasilia, Águas Claras, Taguatinga-DF, 72022-900, Brazil
| | - Carmen Sílvia G Campbell
- Graduate program in Physical Education of the Catholic University of Brasilia, Águas Claras, Taguatinga-DF, 72022-900, Brazil
| | - Pâmella K Morais
- Graduate program in Physical Education of the Catholic University of Brasilia, Águas Claras, Taguatinga-DF, 72022-900, Brazil
| | - Carlos Ernesto
- Graduate program in Physical Education of the Catholic University of Brasilia, Águas Claras, Taguatinga-DF, 72022-900, Brazil
| | - Lúcio F Soares-Caldeira
- Physical Education Faculty of the North University of Parana, Paris avenue, 675, Jardim Piza - Londrina - Paraná, 86041-120, Brazil
| | - Paulo Russo
- Physical Education Faculty of the Federal Institute of Roraima, Capitão Júlio Bezerra avenue, 1392, Aparecida, Boa Vista - Roraíma, 69303-340, Brazil
| | - Daisy F Motta
- Departament of Physiology and Biophysics - Federal University of Minas Gerais, Antônio Carlos avenue, 6627, Pampulha, Belo Horizonte - Minas Gerais, 31270-901, Brazil
| | - Sérgio R Moreira
- Physical Education Faculty of the Federal University of Vale do São Francisco, José de Sá Maniçoba avenue, Center, Petrolina - Pernambuco, 56304-205, Brazil
| | - Fábio Y Nakamura
- Graduate program in Physical Education of the State University of Londrina, Celso Garcia Cid highway, 380 kilometer, Londrina - Paraná, 86051-980, Brazil
| | - Herbert G Simões
- Graduate program in Physical Education of the Catholic University of Brasilia, Águas Claras, Taguatinga-DF, 72022-900, Brazil
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Keet SWM, Bulte CSE, Boer C, Bouwman RA. Reproducibility of non-standardised autonomic function testing in the pre-operative assessment screening clinic*. Anaesthesia 2010; 66:10-4. [DOI: 10.1111/j.1365-2044.2010.06566.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Fujii K, Ogawa K, Tokinaga Y, Iranami H, Hatano Y. Sevoflurane does not alter norepinephrine-induced intracellular Ca²(+) changes in the diabetic rat aorta. Can J Anaesth 2010; 57:1095-101. [PMID: 20845014 DOI: 10.1007/s12630-010-9387-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 09/03/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The effect of volatile anesthetics on the mechanism(s) of vascular contraction in diabetes mellitus (DM) has not been fully understood. The current study was designed to determine the effects of sevoflurane on the norepinephrine (NE)-induced changes in contractile state and intracellular Ca²(+) concentrations ([Ca²(+)](i)) in the spontaneously developing type 2 DM rat. METHODS The effects of sevoflurane on NE (10⁻⁶M)-induced vasoconstriction and increase in [Ca²(+)](i) in the aortas from Otsuka Long-Evans Tokushima Fatty (OLETF) rats, a type 2 DM model, and from age-matched control Long-Evans Tokushima Otsuka (LETO) rats were investigated using an isometric force transducer and fluorometer with fura-2 as an indicator of [Ca²(+)](i). RESULTS Norepinephrine-induced increases in tension and [Ca²(+)](i) in OLETF rats were 54.8%, 95% confidence interval (CI) 36.9-72.6% and 58.8%, 95% CI 51.5-66.1%, respectively, and in LETO rats they were 46.4%, 95% CI 39.0-53.7% and 53.8%, 95% CI 46.9-60.7%, respectively, when expressed as the percentage relative to that induced by KCl 30 mM. In LETO rats, sevoflurane at a concentration of 3.4% inhibited the vascular contraction (9.4%, 95% CI 6.3-12.6%; P < 0.001) and the increase in [Ca²(+)](i) (33.3%, 95% CI 27.4-39.2%; P = 0.002). In OLETF rats, however, sevoflurane failed to affect either the NE-induced contraction (43.6%, 95% CI 28.3-58.9%; P = 0.68) or the elevation in [Ca²(+)](i) (60.5%, 95% CI 56.3-64.8%; P = 0.93). CONCLUSION Sevoflurane at clinically relevant concentrations inhibited the NE-induced increase in [Ca²(+)](i) in the aortic smooth muscle from normal rats but not in that from type 2 DM rats. Thus, a Ca²(+)- signalling pathway resistant to sevoflurane appears to exist in the type 2 DM rat aorta.
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Affiliation(s)
- Keisuke Fujii
- Department of Anesthesiology, Japanese Red Cross Society Wakayama Medical Centre, Japan
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Pavlovic S, Stevic Z, Milovanovic B, Milicic B, Rakocevic-Stojanovic V, Lavrnic D, Apostolski S. Impairment of cardiac autonomic control in patients with amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2010; 11:272-6. [PMID: 20001491 DOI: 10.3109/17482960903390855] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to investigate autonomic cardiac control in patients with amyotrophic lateral sclerosis (ALS). Fifty-five patients with sporadic ALS (28 female and 27 male; average age 56.00 +/- 10.34 years) were compared to 30 healthy controls (17 female and 13 male; average age 42.87 +/- 11.91 years). Patients with previous history of cardiac disease, diabetes mellitus, and impaired respiratory function were excluded from the study. Cardiovascular autonomic tests according to Ewing, power spectrum analysis of RR variability (low- and high-frequency bands - LF and HF, LF/HF index), real-time beat-to-beat ECG signal monitoring with heart rate variability analysis and baroreflex function analysis were carried out in all patients. Time-domain parameters of heart rate variability (mean RR interval, SDNN, SDANN, SDNN index, rMSSD and pNN50%) were obtained from 24-h ECG monitoring. ALS patients had a significantly higher score of sympathetic (p <0.01) and parasympathetic (p <0.001) dysfunction, as well as of the overall score of autonomic dysfunction (p <0.001). LF/HF index was significantly increased; baroreflex sensitivity and time-domain parameters of heart rate variability were highly significantly decreased in ALS patients (p <0.001). Our results demonstrated impaired cardiac autonomic control in ALS with marked parasympathetic dysfunction and sympathetic predominance.
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Affiliation(s)
- Sanja Pavlovic
- Neurocardiological Laboratory, Clinical Centre Bezanijska Kosa, Belgrade, Serbia.
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Fadul N, Strasser F, Palmer JL, Yusuf SW, Guo Y, Li Z, Allo J, Bruera E. The association between autonomic dysfunction and survival in male patients with advanced cancer: a preliminary report. J Pain Symptom Manage 2010; 39:283-90. [PMID: 20152590 DOI: 10.1016/j.jpainsymman.2009.06.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 06/09/2009] [Accepted: 06/26/2009] [Indexed: 11/25/2022]
Abstract
CONTEXT Autonomic nervous system dysfunction (AD) is a common syndrome in patients with advanced cancer. It is associated with decreased survival in several patient populations, including diabetes mellitus, heart failure, and neurological diseases. Based on this evidence, we hypothesized that autonomic dysfunction is associated with decreased survival in patients with advanced cancer. OBJECTIVES The objective of this preliminary study was to test the association between AD, as measured by the standardized Ewing test and heart rate variability (HRV) measures, and survival in this patient population. METHODS We examined the relationship between survival and parameters of AD in subjects who participated in a prospective study of autonomic dysfunction and hypogonadism in male patients with advanced cancer. Eligibility criteria were defined based on the prospective study protocol. We collected demographic information, date of death (obtained from the online Social Security Death Index database), date of study entry, and Ewing and HRV scores. We defined survival as the interval between study entry and date of death. A survival analysis was used to test the association between survival (in days) and Ewing test (0-5) and measures of HRV, including time domain (standard deviation of normal to normal beat interval [SDNN]) and frequency domain (ultra low, very low, low, and high). Four patients were still alive at the time of this study and included in the survival analysis as being censored. RESULTS Forty-seven male patients were included in this study. Median age was 59 years (range: 20-79), and 30 out of 47 (63%) were Caucasians. AD, defined as Ewing score greater than 2, was present in 38 out of 47 (80%) of the patients. Median Ewing score was 3 (1-5), indicating moderate to severe AD. Spearman correlation for Ewing score and SDNN was 0.44 (P = 0.002). There was a significant association between abnormal Ewing score and survival (P < 0.0001) and abnormal SDNN HRV and survival (P = 0.056). CONCLUSION AD is associated with shorter survival in male patients with advanced cancer. Further longitudinal research in a large cohort is justified based on.
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Affiliation(s)
- Nada Fadul
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Vrtovec B, Fister M, Poglajen G, Starc V, Haddad F. Diabetes does not affect ventricular repolarization and sudden cardiac death risk in patients with dilated cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32 Suppl 1:S146-50. [PMID: 19250080 DOI: 10.1111/j.1540-8159.2008.02272.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND We studied the effects of diabetes on ventricular repolarization parameters and sudden cardiac death in patients with dilated cardiomyopathy (DCM). METHODS We enrolled 132 consecutive patients in New York Heart Association (NYHA) heart failure functional classes II or III and left ventricular ejection fraction <40% without evidence of coronary artery disease. In 45 patients (34%), diabetes was diagnosed according to standard criteria (study group), and the remaining 87 (66%) had no diabetes (controls). All patients underwent a 5-minute high-resolution electrocardiogram recording for determination of QT variability (QTV) index and were followed for 1 year thereafter. RESULTS At baseline, the two groups did not differ in age, gender, left ventricular ejection fraction, NYHA functional class, or plasma brain natriuretic peptide levels. Similarly, QTV index did not differ between the study group (-0.51 +/- 0.55) and controls (-0.48 +/- 0.51; P = 0.48). During follow-up, 18 patients (14%) died of cardiac causes. Of the 18 deaths, eight were attributed to heart failure, and 10 to sudden cardiac death. Mortality was higher in the study group (10/45, 20%) than in controls (8/87, 10%) (P = 0.03). The same was true of the heart failure mortality (6/45 [13%] vs 2/87 [2%], P = 0.01), but not of the sudden cardiac death rate (3/45 [7%] vs 7/87 [8%], P = 0.78). By multiple variable analyses, diabetes predicted total and heart failure mortality, and a high QTV predicted sudden cardiac death. CONCLUSIONS Diabetes appears to increase the risk of heart failure in patients with DCM without affecting ventricular repolarization parameters and sudden cardiac death risk.
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Affiliation(s)
- Bojan Vrtovec
- Advanced Heart Failure Center, Department of Cardiology, Ljubljana University Medical Center, Ljubljana, Slovenia.
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Diabetes and cardiovascular autonomic dysfunction: application of animal models. Auton Neurosci 2008; 145:3-10. [PMID: 19054720 DOI: 10.1016/j.autneu.2008.10.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 10/17/2008] [Accepted: 10/21/2008] [Indexed: 12/21/2022]
Abstract
When diabetes is associated with cardiovascular autonomic dysfunction, there is a poor prognosis and increased morbidity and mortality. Information on the mechanisms of diabetes-associated autonomic dysfunction has been provided by advanced studies using physiological, pharmacological, anatomical and molecular methods in experimental animal models of insulin deficiency and resistance. This has been augmented by new approaches which combine diabetes induction with genetically modified animal models. The aim of this review is to outline and discuss the animal models used for the study of insulin deficiency and insulin resistance with a focus on autonomic neural interactions. The goal is to better understand the clinical relevance of cardiovascular autonomic dysfunction associated with diabetes.
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Ko SH, Song KH, Park SA, Kim SR, Cha BY, Son HY, Moon KW, Yoo KD, Park YM, Cho JH, Yoon KH, Ahn YB. Cardiovascular autonomic dysfunction predicts acute ischaemic stroke in patients with Type 2 diabetes mellitus: a 7-year follow-up study. Diabet Med 2008; 25:1171-7. [PMID: 19046195 DOI: 10.1111/j.1464-5491.2008.02567.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS We investigated whether cardiovascular autonomic neuropathy (CAN) is associated with acute ischaemic stroke in patients with Type 2 diabetes. METHODS From 1999 to 2000, cardiovascular autonomic function tests were conducted in patients with Type 2 diabetes (n = 1458). Patients were followed up between 2006 and 2007. Standard tests for CAN measured heart rate variability parameters [expiration-to-inspiration (E/I) ratio, responses to the Valsalva manoeuvre and standing]. Using the American Diabetes Association criteria, the CAN scores were determined from the results of each test as follows: 0 = normal, 1 = abnormal (total maximum score 3). We assessed the development of acute ischaemic stroke events. RESULTS The prevalence of CAN at baseline was 55.7% (E/I 17.1%, Valsalva 39.4%, posture 27.3%) (n = 1126). During follow-up, 131 patients (11.6%) developed acute ischaemic stroke. The vascular events were more frequent in older patients (P < 0.001) and in those with diabetes of longer duration (P = 0.022), hypertension (P < 0.001) or diabetic retinopathy (P = 0.03) than in patients without vascular events. Patients with ischaemic stroke had higher creatinine levels (P = 0.045) and higher urine albumin excretion (P = 0.025) than those of patients without stroke. Cox proportional hazard regression analysis revealed that the CAN score was associated with the development of acute ischaemic stroke (total score 0 vs. 3, adjusted hazard ratio 2.7, 95% CI 1.3-5.5, P = 0.006). CONCLUSION Cardiovascular autonomic dysfunction was significantly associated with the development of ischaemic stroke in patients with Type 2 diabetes.
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Affiliation(s)
- S H Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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Ko SH, Park SA, Cho JH, Song KH, Yoon KH, Cha BY, Son HY, Yoo KD, Moon KW, Park YM, Ahn YB. Progression of cardiovascular autonomic dysfunction in patients with type 2 diabetes: a 7-year follow-up study. Diabetes Care 2008; 31:1832-6. [PMID: 18509202 PMCID: PMC2518354 DOI: 10.2337/dc08-0682] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We investigated whether cardiovascular autonomic dysfunction was associated with glycemic control status over time in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS From 1999 to 2000, cardiovascular autonomic nerve function testing (AFT) was performed on patients with type 2 diabetes (n = 1,021) and was followed-up in 2006 and February 2008. Tests for cardiovascular autonomic functions measured heart rate variability parameters (expiration-to-inspiration [E/I] ratio, responses to the Valsalva maneuver, and standing). AFT scores were determined from the results of the each test as follows: 0 for normal and 1 for abnormal. We began with those who had a score of 0 and assessed the changes in total score along with biannual A1C levels. RESULTS At follow-up, the development of cardiovascular autonomic dysfunction was 34.5% (E/I ratio 21.9%, Valsalva maneuver 77.8%, and posture 58.9%; n = 783). The development of cardiovascular autonomic dysfunction was higher in older patients (P < 0.001); in those with longer duration of diabetes (P < 0.001); of hypertension (P = 0.005), and of diabetic retinopathy (P < 0.001); and in those who had higher levels of microalbuminuria (P = 0.002). Logistic regression analysis revealed that the development of cardiovascular autonomic dysfunction was strongly associated with the mean A1C level during the follow-up period (mean A1C >9.0% vs. <or=7.0%, odds ratio 2.984, 95% CI 1.177-7.561; P = 0.021). CONCLUSIONS The development of cardiovascular autonomic dysfunction was independently associated with microvascular complications and glycemic control status during this 7.5-year follow-up in patients with type 2 diabetes.
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Affiliation(s)
- Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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Kurashige S, Takakura K, Mizogami M. Repeated sudden falls in heart rate in a diabetic patient during sevoflurane anesthesia. J Anesth 2008; 22:167-9. [DOI: 10.1007/s00540-007-0591-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 11/02/2007] [Indexed: 10/22/2022]
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Gärtner C, Walz L, Bauernschmitt E, Ladwig KH. The causes of prehospital delay in myocardial infarction. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:286-91. [PMID: 19629234 DOI: 10.3238/arztebl.2008.0286] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 11/28/2007] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The elapsed time between the onset of symptoms and reperfusion is a critical determinant of the clinical course of patients with myocardial infarction. The patients' own decision time is the most important component of prehospital delay. METHODS Selective literature review based on the references in a meta-analysis, complemented by a PubMed search on the expression "prehospital delay" in combination with "myocardial infarction," "acute coronary syndrome," "psychological factors," "gender," and "public campaign." A total of 73 papers addressing factors that influence prehospital delay were selected. RESULTS The reasons for delays of more than 120 minutes in a patient with symptoms of myocardial infarction reaching the hospital are still not sufficiently elucidated. Patients' uncertainty about their symptoms, advanced age, and female sex are three factors that appear to be associated with longer delays. DISCUSSION Factors influencing prehospital delay operate at the following levels: the perception of acute symptoms, the recognition of the importance of these symptoms, and the decision to call for help. Intervention trials should consider these levels in meeting the needs of clinically relevant subpopulations.
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Affiliation(s)
- Cornelia Gärtner
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie des Klinikums rechts der Isar, Technische Universität München, Munich, Germany
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Pappachan JM, Sebastian J, Bino BC, Jayaprakash K, Vijayakumar K, Sujathan P, Adinegara LA. Cardiac autonomic neuropathy in diabetes mellitus: prevalence, risk factors and utility of corrected QT interval in the ECG for its diagnosis. Postgrad Med J 2008; 84:205-10. [PMID: 18424578 DOI: 10.1136/pgmj.2007.064048] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To study the prevalence and risk factors for cardiac autonomic neuropathy (CAN) and the utility of prolongation of corrected QT interval (QTc) in the ECG to diagnose CAN in patients with diabetes mellitus. DESIGN AND SETTING Cross-sectional study conducted among patients attending the diabetic clinic of a teaching hospital. METHODS The prevalence of CAN among 100 patients with type 1 and type 2 diabetes mellitus was assessed by the five autonomic function tests by Eving's methodology. The CAN score in each patient and its relationship to the QTc interval were analysed. Possible influences of age, duration of diabetes and coexistent peripheral neuropathy on the occurrence of CAN also were studied. RESULTS The prevalence of CAN was 60%. Univariate analysis showed a significant association between CAN and higher age (odds ratio (OR) 15.75), prolongation of QTc (OR 5.55), duration of disease over 10 years (OR 2) and peripheral neuropathy (p<0.001) in patients with type 1 diabetes. Significant risks for CAN among patients with type 2 diabetes were coexistent peripheral neuropathy (OR 14), prolonged QTc (OR 9.75), higher age (OR 7.2) and disease duration over 10 years (OR 1.92) in univariate analysis, but none of them showed independent risk in multivariate analysis. Disease duration over 10 years resulted in QTc prolongation in a significant numbers of cases with type 1 (p<0.001) and type 2 (p = 0.006) diabetes. The sensitivity, specificity and positive predictive value of QTc prolongation for the diagnosis of CAN were 77%, 62.5% and 77% in type 1 and 76.5%, 75% and 81.3% in type 2, respectively. Higher CAN scores correlated with longer QTc intervals (coefficient of correlation 0.73; p<0.001). CONCLUSIONS The prevalence of CAN in diabetes mellitus is high. Higher age, longer duration of diabetes and peripheral neuropathy are significant risk factors. QTc interval in the ECG can be used to diagnose CAN with reasonable sensitivity, specificity and positive predictive value.
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Affiliation(s)
- J M Pappachan
- Kottayam Medical College, Kottayam, Kerala, South India.
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Boysen A, Lewin MA, Hecker W, Leichter HE, Uhlemann F. Autonomic function testing in children and adolescents with diabetes mellitus. Pediatr Diabetes 2007; 8:261-4. [PMID: 17850468 DOI: 10.1111/j.1399-5448.2007.00254.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Cardiac autonomic neuropathy (CAN) is a common complication in type 1 diabetes mellitus (T1DM) and associated with an increased mortality. Early detection of CAN would be desirable for a better individual risk stratification. The aim of this study was to determine whether autonomic dysfunction can be diagnosed in young patients with a recent history of T1DM. Autonomic function was assessed in 20 pediatric patients with T1DM, aged 10-19 yr, and a control group of 136 non-diabetic patients using four cardiorespiratory reflexes: heart rate and blood pressure response in standing position, deep breathing, and Valsalva maneuver. Furthermore, power spectral analyses of the low- and high-frequency band of heart rate variability (HRV) and baroreflex sensitivity (BRS) were tested with the non-invasive Task force monitor (CNSystems, Graz, Austria). Cardiorespiratory reflexes were pathologic for at least one item in 75% of the diabetic and 60% in the healthy control group. A reduced BRS was always combined with abnormal HRV. We found this pattern in 30% of diabetic patients and never in the control group. In patients with impaired BRS, mean hemoglobin A1c (HbA1c) was 7.7% and duration of diabetes 6.5 yr. This did not differ from the overall value of the diabetic group: HbA1c level 8.4% and diabetes duration 7.3 yr. In conclusion, signs of autonomic dysfunction are not uncommon in an early stage of diabetes in young patients. Classical cardiorespiratory reflexes seem to be less specific than HRV and BRS as testing methods.
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Affiliation(s)
- Arnulf Boysen
- Department of Pediatric Cardiology, University Graz, Graz, Austria.
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Morphology and topography of nucleus ambiguus projections to cardiac ganglia in rats and mice. Neuroscience 2007; 149:845-60. [PMID: 17942236 DOI: 10.1016/j.neuroscience.2007.07.062] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 06/30/2007] [Accepted: 08/18/2007] [Indexed: 12/13/2022]
Abstract
Vagal efferent axons from the nucleus ambiguus (NA) innervate ganglionated plexuses in the dorsal surface of cardiac atria, which in turn, may have different functional roles in cardiac regulation. However, the morphology and topography of vagal efferent projections to these ganglionated plexuses in rats and mice have not been well delineated. In the present study, we injected the tracer 1,1'-dioctadecyl-3,3,3',3' tetramethylindocarbocyanine methanesulfonate (DiI) into the left NA to label vagal efferent axons and terminals in cardiac ganglia and administered Fluoro-Gold (FG) i.p. to stain cardiac ganglia. Then, we used confocal microscopy and a Neurolucida 3-D Digitization System to qualitatively and quantitatively examine the distribution and structure of cardiac ganglia, and NA efferent projections to cardiac ganglia in the whole-mounts of Sprague-Dawley (SD) rats and FVB mice. Our observations were: 1) Cardiac ganglia of different shapes and sizes were distributed in the sinoatrial (SA) node, atrioventricular (AV) node, and lower pulmonary vein (LPV) regions on the dorsal surface of the atria. In each region, several ganglia formed a ganglionated plexus. The plexuses at different locations were interconnected by nerves. 2) Vagal efferent fibers ramified within cardiac ganglia, formed a complex network of axons, and innervated cardiac ganglia with very dense basket endings around individual cardiac principal neurons (PNs). 3) The percent of the PNs in cardiac ganglia which were innervated by DiI-labeled axons was 54.3+/-3.2% in mice vs. 53.2+/-3.2% in rats (P>0.10). 4) The density of axonal putative-synaptic varicosities on the surface of PNs was 0.15+/-0.02/microm(2) in mice vs. 0.16+/-0.02/microm(2) in rats (P>0.10). Thus, the distributions of cardiac ganglia and vagal efferent projections to cardiac ganglia in mice and rats were quite similar both qualitatively and quantitatively. Our study provides the structural foundation for future investigation of functional differentiation of ganglionated plexuses and the brain-heart circuitry in rodent models of human disease.
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Bilen H, Atmaca A, Akcay G. Neuropad indicator test for diagnosis of sudomotor dysfunction in type 2 diabetes. Adv Ther 2007; 24:1020-7. [PMID: 18029328 DOI: 10.1007/bf02877707] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Neuropad is a new indicator test used to diagnose sudomotor dysfunction, a component of autonomic neuropathy. In this cross-sectional study, Neuropad is evaluated and compared with corrected QT (QT c), another test used in the diagnosis of autonomic neuropathy. The indicator test measures sweat production on the basis of a color change of cobalt (II) chloride solution from blue to pink upon absorption of water. This study involved 105 patients (43 men, 62 women) with type 2 diabetes with a mean age of 56.2+/-11.5 y and a mean disease duration of 10.0+/-6.3 y. Age, sex, disease duration, glycosylated hemoglobin, and QT c were compared between patients with normal and abnormal test results. The QT c interval was measured and the new indicator test was applied in all patients. The 2 tests were compared, and the sensitivity, specificity, positive predictive value, and negative predictive value for the indicator test were calculated. Autonomic neuropathy was diagnosed in 40 patients (38.1%) with QT c interval measurement and in 72 patients (68.6%) with the new indicator test (P=.001). The sensitivity, specificity, positive predictive value, and negative predictive value for the indicator test were 87.5%, 43.1%, 48.6%, and 84.8%, respectively. Patients with abnormal test outcomes had longer QT c than those whose test results were normal (0.433 vs 0.398 s; P=.002). Study results suggest that the new indicator test has an acceptable sensitivity but a low specificity and is not superior to other tests in the diagnosis of sudomotor dysfunction.
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Affiliation(s)
- Habib Bilen
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Ataturk University School of Medicine, Erzurum, Turkey.
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Heikkinen M, Salmenperä M, Lepäntalo A, Lepäntalo M. Diabetes Care for Patients with Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2007; 33:583-91. [PMID: 17368940 DOI: 10.1016/j.ejvs.2007.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 01/30/2007] [Indexed: 02/02/2023]
Abstract
The number of diabetics will increase almost 70% in developed countries during the next 20 years: peripheral arterial disease is a common and costly complication. The incidence of cardiovascular disease (mortality and morbidity) due to atherosclerosis, is higher among patients with diabetes than in those without diabetes. Intensive management of diabetes, including glycaemic control, treatment of hypertension and dyslipidemia, as well as nonpharmacological interventions, decreases both micro- and macrovascular complications. Aspirin and clopidogrel have less antiplatelet effect in patients with diabetes. Metformin therapy is considered a risk factor for lactic acidosis if not withdrawn 2 days before angiography, but this risk is extremely low in patients with normal renal function. Peri-operative hyperglycaemia and large fluctuations in plasma glucose increase postoperative mortality and morbidity and careful measures are required to minimise these effects.
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Affiliation(s)
- M Heikkinen
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
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Ma H, Niu Y, Wang Z, Li Z, Hua M, Xie Z. Association of the spectral features of heart period signal with SNP of NOS in the Chinese Han nationality population. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2005:2463-6. [PMID: 17282736 DOI: 10.1109/iembs.2005.1616967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
To explore association of the spectral features of heart period signal with SNPs at 5 sites of NOS gene in the subjects (male89, female77, aged 62.40+/-2.5 yrs) by allele specific primer PCR technique. It was found that the TT allelic genotype of NOS2 C-1173T associated with the highest RPH and TT allelic genotype of NOS3 G894T associated with the highest APH in HPS spectral parameters. This suggests the SNPs of NOS2 C-1173T and NOS3 G894T may be the deep layer factors to result in the variability of HPS spectral parameters.
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Affiliation(s)
- H Ma
- Dept. of Geriatric, Chongqing Univ. of Med. Sci
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Yim EB, Baik HJ, Kim JH, Kim YJ. Heart Rate Variability during Propofol-Remifentanil TCI Induction in Diabetic Patients. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.2.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Eun Bin Yim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Hee Jung Baik
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jong Hak Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Yoon Jin Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
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Voss A, Baier V, Schulz S, Bar KJ. Linear and nonlinear methods for analyses of cardiovascular variability in bipolar disorders. Bipolar Disord 2006; 8:441-52. [PMID: 17042882 DOI: 10.1111/j.1399-5618.2006.00364.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Heart rate variability (HRV), blood pressure variability (BPV), and the assessment of baroreflex sensitivity are widely accepted methods for analyzing and characterizing cardiovascular regulation and for an enhanced risk evaluation in different diseases. As a result of the complexity of the investigated regulatory systems, univariate analyses do not often provide a convenient description of pathological changes in the cardiovascular regulation. Therefore, the application of a multivariate approach is preferable. METHODS We present principal methods of time-domain, frequency-domain, and nonlinear analyses of HRV, BPV as well as methods for coupling and interaction analyses. RESULTS Changes in autonomic nervous system (ANS) tone are known to accompany various mental disorders. Depressive patients frequently complain of symptoms of ANS dysfunction, such as dry mouth, diarrhea, and insomnia. These clinical observations propose the assumption of altered autonomic dysfunction in these patients. In contrast to these clinical assumptions, inconsistent results have been found in studies of HRV in depressive patients. This work therefore covers a brief review of the literature in respect to bipolar disorder and the rationale to study autonomic changes in such a psychiatric disease. CONCLUSIONS Prospective studies of cardiovascular changes in mania and depression are needed to evaluate a psychopathological state in connection with cardiovascular changes and cardiac morbidity and mortality. These studies should consider BPV, coupling and interaction analyses, the application of nonlinear methods, and a multivariate approach in addition to the traditional analysis of HRV.
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Affiliation(s)
- A Voss
- Department of Medical Engineering, University of Applied Sciences Jena, Jena, Germany.
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Xiao X, Mullen TJ, Mukkamala R. System identification: a multi-signal approach for probing neural cardiovascular regulation. Physiol Meas 2005; 26:R41-71. [PMID: 15798289 DOI: 10.1088/0967-3334/26/3/r01] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Short-term, beat-to-beat cardiovascular variability reflects the dynamic interplay between ongoing perturbations to the circulation and the compensatory response of neurally mediated regulatory mechanisms. This physiologic information may be deciphered from the subtle, beat-to-beat variations by using digital signal processing techniques. While single signal analysis techniques (e.g., power spectral analysis) may be employed to quantify the variability itself, the multi-signal approach of system identification permits the dynamic characterization of the neural regulatory mechanisms responsible for coupling the variability between signals. In this review, we provide an overview of applications of system identification to beat-to-beat variability for the quantitative characterization of cardiovascular regulatory mechanisms. After briefly summarizing the history of the field and basic principles, we take a didactic approach to describe the practice of system identification in the context of probing neural cardiovascular regulation. We then review studies in the literature over the past two decades that have applied system identification for characterizing the dynamical properties of the sinoatrial node, respiratory sinus arrhythmia, and the baroreflex control of sympathetic nerve activity, heart rate and total peripheral resistance. Based on this literature review, we conclude by advocating specific methods of practice and that future research should focus on nonlinear and time-varying behaviors, validation of identification methods, and less understood neural regulatory mechanisms. Ultimately, we hope that this review stimulates such future investigations by both new and experienced system identification researchers.
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Affiliation(s)
- Xinshu Xiao
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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