Chronodromotropic coordination in cats

The autonomic balance predicts cardiac responses after the first dose of fingolimod

BACKGROUND

Predictive markers of cardiac side effects would be helpful for the stratification and individualized monitoring of multiple sclerosis (MS) patients prescribed with fingolimod.

OBJECTIVE

To test whether the autonomic balance predicts a cardiac response after the first dose of fingolimod.

METHODS

A total of 55 consecutive relapsing-remitting MS (RRMS) patients underwent 'head-up tilt', Valsalva maneuver, deep breathing and handgrip tests before their first dose of fingolimod. The normalized unit of the high frequency (HF) component (HF normalized units; HFnu), reflecting mostly vagal activity; and the low frequency (LF) component (LF normalized units; LFnu) reflecting mostly sympathetic activity, were considered for the analysis of heart rate (HR) variability. The patients' HR and electrocardiographic parameters ((the interval between P wave and ventricular depolarization (PR); the interval between Q and T waves (QT)) were recorded during 6-hour post-dose monitoring.

RESULTS

We found significant correlations between measures of parasympathetic function and fingolimod-induced bradycardia. Subjects with higher Valsalva ratio and HR variation during deep breathing had, in fact, nadir HR ≤ 50 beats/minute (bpm) after the first fingolimod dose. Conversely, significant negative correlations were found between measures of sympathetic function and fingolimod-induced PR interval increase. Subjects with lower LFnu at rest and less increase of blood pressure on the handgrip test showed a PR interval increase > 20 ms after fingolimod.

CONCLUSIONS

Assessing autonomic control of cardiovascular functions can be useful to predict cardiac effects after the first fingolimod dose.

Effect of pentobarbital on spectral characteristics and phase ratios of wave oscillations of cardiac contraction period and time of atrioventricular conduction in cats

Effects of pentobarbital on spectral characteristics and phase ratios of wave oscillations of the cardiac contraction period (RR interval) and time of atrioventricular conduction (AV interval) were studied in experiments of cats. Pentobarbital moderately reduced the mean values of both intervals and significantly reduced their standard deviations and spectral powers in all frequency bands (high-frequency, low-frequency, and very low-frequency). Pentobarbital treatment led to deceleration of breathing, the frequency range of respiratory oscillations of RR and AV intervals shifted in some cases from high to low frequencies; evaluation of spectral power in the intermittent band corresponding to respiration frequency (instead of standard fixed high-frequency band) showed that pentobarbital suppressed the respiratory oscillations in these bands. Pentobarbital induced inversion of phase ratio between respiratory oscillations of RR and AV intervals: oscillations of both intervals before pentobarbital coincided by phase, while after pentobarbital injection they were in antiphase. The mechanisms of the latter phenomenon deserve further investigation.