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van Campen C(LM, Verheugt FW, Rowe PC, Visser FC. Orthostatic chronotropic incompetence in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). IBRO Neurosci Rep 2023; 15:1-10. [PMID: 37303862 PMCID: PMC10250802 DOI: 10.1016/j.ibneur.2023.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/25/2023] [Accepted: 04/30/2023] [Indexed: 06/13/2023] Open
Abstract
Background Orthostatic intolerance (OI) is a core diagnostic criterion in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The majority of ME/CFS patients have no evidence of hypotension or postural orthostatic tachycardia syndrome (POTS) during head-up tilt, but do show a significantly larger reduction in stroke volume index (SVI) when upright compared to controls. Theoretically a reduction in SVI should be accompanied by a compensatory increase in heart rate (HR). When there is an incomplete compensatory increase in HR, this is considered chronotropic incompetence. This study explored the relationship between HR and SVI to determine whether chronotropic incompetence was present during tilt testing in ME/CFS patients. Methods From a database of individuals who had undergone tilt testing with Doppler measurements for SVI both supine and end-tilt, we selected ME/CFS patients and healthy controls (HC) who had no evidence of POTS or hypotension during the test. To determine the relation between the HR increase and SVI decrease during the tilt test in patients, we calculated the 95% prediction intervals of this relation in HC. Chronotropic incompetence in patients was defined as a HR increase below the lower limit of the 95th % prediction interval of the HR increase in HC. Results We compared 362 ME/CFS patients with 52 HC. At end-tilt, tilt lasting for 15 (4) min, ME/CFS patients had a significantly lower SVI (22 (4) vs. 27 (4) ml/m2; p < 0.0001) and a higher HR (87 (11) vs. 78 (15) bpm; p < 0.0001) compared to HC. There was a similar relationship between HR and SVI between ME/CFS patients and HC in the supine position. During tilt ME/CFS patients had a lower HR for a given SVI; 37% had an inadequate HR increase. Chronotropic incompetence was more common in more severely affected ME/CFS patients. Conclusion These novel findings represent the first description of orthostatic chronotropic incompetence during tilt testing in ME/CFS patients.
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Affiliation(s)
| | | | - Peter C. Rowe
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Frans C. Visser
- Stichting CardioZorg, Planetenweg 5, 2132 HN Hoofddorp, The Netherlands
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2
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Stoner L, Higgins S, Paterson C. The 24-h activity cycle and cardiovascular outcomes: establishing biological plausibility using arterial stiffness as an intermediate outcome. Am J Physiol Heart Circ Physiol 2023; 325:H1243-H1263. [PMID: 37737729 DOI: 10.1152/ajpheart.00258.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/07/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Abstract
This review proposes a biologically plausible working model for the relationship between the 24-h activity cycle (24-HAC) and cardiovascular disease. The 24-HAC encompasses moderate-to-vigorous physical activity (MVPA), light physical activity, sedentary behavior (SB), and sleep. MVPA confers the greatest relative cardioprotective effect, when considering MVPA represents just 2% of the day if physical activity guidelines (30 min/day) are met. While we have well-established guidelines for MVPA, those for the remaining activity behaviors are vague. The vague guidelines are attributable to our limited mechanistic understanding of the independent and additive effects of these behaviors on the cardiovascular system. Our proposed biological model places arterial stiffness, a measure of vascular aging, as the key intermediate outcome. Starting with prolonged exposure to SB or static standing, we propose that the reported transient increases in arterial stiffness are driven by a cascade of negative hemodynamic effects following venous pooling. The subsequent autonomic, metabolic, and hormonal changes further impair vascular function. Vascular dysfunction can be offset by using mechanistic-informed interruption strategies and by engaging in protective behaviors throughout the day. Physical activity, especially MVPA, can confer protection by chronically improving endothelial function and associated protective mechanisms. Conversely, poor sleep, especially in duration and quality, negatively affects hormonal, metabolic, autonomic, and hemodynamic variables that can confound the physiological responses to next-day activity behaviors. Our hope is that the proposed biologically plausible working model will assist in furthering our understanding of the effects of these complex, interrelated activity behaviors on the cardiovascular system.
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Affiliation(s)
- Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Department of Epidemiology, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Simon Higgins
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Craig Paterson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
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3
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Värri E, Suojanen L, Koskela JK, Choudhary MK, Tikkakoski A, Kähönen M, Nevalainen PI, Mustonen J, Pörsti I. Ambulatory daytime blood pressure versus tonometric blood pressure measurements in the laboratory: effect of posture. Blood Press Monit 2023; 28:199-207. [PMID: 37318783 PMCID: PMC10309093 DOI: 10.1097/mbp.0000000000000651] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/23/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To compare blood pressure (BP) in tonometric radial artery recordings during passive head-up tilt with ambulatory recordings and evaluate possible laboratory cutoff values for hypertension. METHODS Laboratory BP and ambulatory BP were recorded in normotensive (n = 69), unmedicated hypertensive (n = 190), and medicated hypertensive (n = 151) subjects. RESULTS Mean age was 50.2 years, BMI 27.7 kg/m 2 , ambulatory daytime BP 139/87 mmHg, and 276 were male (65%). As supine-to-upright changes in SBP ranged from -52 to +30 mmHg, and in DBP from -21 to +32 mmHg, the mean values of BP supine and upright measurements were compared with ambulatory BP. The mean(supine+upright) systolic laboratory BP was corresponding to ambulatory level (difference +1 mmHg), while mean(supine+upright) DBP was 4 mmHg lower ( P < 0.05) than ambulatory value. Correlograms indicated that laboratory 136/82 mmHg corresponded to ambulatory 135/85 mmHg. When compared with ambulatory 135/85 mmHg, the sensitivity and specificity of laboratory 136/82 mmHg to define hypertension were 71.5% and 77.3% for SBP, and 71.7% and 72.8%, for DBP, respectively. The laboratory cutoff 136/82 mmHg classified 311/410 subjects similarly to ambulatory BP as normotensive or hypertensive, 68 were hypertensive only in ambulatory, while 31 were hypertensive only in laboratory measurements. CONCLUSION BP responses to upright posture were variable. When compared with ambulatory BP, mean(supine+upright) laboratory cutoff 136/82 mmHg classified 76% of subjects similarly as normotensive or hypertensive. In the remaining 24% the discordant results may be attributed to white-coat or masked hypertension, or higher physical activity during out-of-office recordings.
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Affiliation(s)
- Emmi Värri
- Faculty of Medicine and Health Technology, Tampere University, Departments of
| | - Lauri Suojanen
- Faculty of Medicine and Health Technology, Tampere University, Departments of
- Internal Medicine
| | - Jenni K. Koskela
- Faculty of Medicine and Health Technology, Tampere University, Departments of
- Internal Medicine
| | - Manoj K. Choudhary
- Faculty of Medicine and Health Technology, Tampere University, Departments of
| | - Antti Tikkakoski
- Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Departments of
- Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | | | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Departments of
- Internal Medicine
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, Departments of
- Internal Medicine
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4
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Zieff G, Stone K, Paterson C, Fryer S, Diana J, Blackwell J, Meyer ML, Stoner L. Pulse-wave velocity assessments derived from a simple photoplethysmography device: Agreement with a referent device. Front Cardiovasc Med 2023; 10:1108219. [PMID: 36824455 PMCID: PMC9941627 DOI: 10.3389/fcvm.2023.1108219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Objective Pulse-wave velocity (PWV), a common measure of arterial stiffness, can be measured continuously and across multiple body sites using photoplethysmography (PPG). The objective was to determine whether a simple photoplethysmography PPG PWV method agrees with a referent device. Approach Photoplethysmography heart-finger PWV (hfPWV) and heart-toe PWV (htPWV) were compared to oscillometric carotid-wrist PWV (cwPWV) and carotid-ankle PWV (caPWV) referent measurements, respectively. In 30 adults (24.6 ± 4.8 years, body mass index 25.2 ± 5.9 kg/m2, 18 female), three measurements were made: two supine baseline measurements (Base 1, Base 2) and one measurement (Tilt) 5 min after a modified head-up tilt test (mHUTT). Overall agreement and repeated measures agreement (change in PPG PWV from Base to Tilt vs. change in referent PWV from Base to Tilt) were calculated using linear mixed models. Agreement estimates were expressed as intra-class correlation coefficients (ICC). Main results For hfPWV there was strong overall agreement (ICC: 0.77, 95%CI: 0.67-0.85), but negligible and non-significant repeated measures agreement (ICC: 0.10, 95%CI: -0.18 to 0.36). For htPWV, there was moderate overall agreement (ICC:0.50, 95%CI: 0.31-0.65) and strong repeated measures agreement (ICC: 0.81, 95%CI: 0.69-0.89). Significance Photoplethysmography can continuously measure PWV at multiple arterial segments with moderate-strong overall agreement. While further work with upper-limb PPG PWV is needed, PPG can adequately capture acute changes in lower-limb PWV.
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Affiliation(s)
- Gabriel Zieff
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States,*Correspondence: Gabriel Zieff,
| | - Keeron Stone
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Craig Paterson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States,School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Simon Fryer
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Jake Diana
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jade Blackwell
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States,Department of Physiology, The University of Arizona, Tucson, AZ, United States
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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5
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Dorogovtsev VN, Yankevich DS, Petrova MV, Torshin VI, Severin AE, Borisov IV, Podolskaya JA, Grechko AV. Detection of Preclinical Orthostatic Disorders in Young African and European Adults Using the Head-Up Tilt Test with a Standardized Hydrostatic Column Height: A Pilot Study. Biomedicines 2022; 10:biomedicines10092156. [PMID: 36140257 PMCID: PMC9496141 DOI: 10.3390/biomedicines10092156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Arterial hypertension (AH) remains the most common disease. One possible way to improve the effectiveness of the primary prevention of AH is to identify and control the preclinical orthostatic disturbances that precede the development of AH. The aim of the study was to determine the feasibility of a new protocol for the head-up tilt test (HUTT) with a standardized hydrostatic column height for the detection of asymptomatic orthostatic circulatory disorders and their racial differences in young African and European adults. Methods. In total, 80 young healthy adults (40 African and 40 European) aged 20–23 years performed the HUTT with a standardized hydrostatic column height of 133 cm. The hemodynamic parameters were recorded using a Task Force Monitor (3040i). The cardio-ankle vascular index (CAVI) was measured using a VaSera VS-2000 volumetric sphygmograph. Results. The baseline and orthostatic hemodynamic changes in both racial groups were within normal limits. Orthostatic circulatory disturbances were not detected in 70% of the European participants and 65% of the African participants; however, preclinical orthostatic hypertension, which precedes AH, was detected using the new HUTT protocol in 32.5% of the African participants and 20% of the European participants. The baseline CAVI was higher in the European group compared to the African group. Conclusion. The results of this study showed the feasibility of the detection of preclinical orthostatic disturbances in young adults and the detection of their racial differences using the HUTT protocol, providing the use of a standard gravity load. Further study on the evolution of preclinical orthostatic disturbances and their relation to increased vascular stiffness is necessary among large samples.
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Affiliation(s)
- Victor N. Dorogovtsev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia
- Correspondence:
| | - Dmitry S. Yankevich
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia
| | - Marina V. Petrova
- Department of Anesthesiology and Resuscitation with Medical Rehabilitation Courses, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia
| | - Vladimir I. Torshin
- Department of Normal Physiology, and Department of Anesthesiology and Resuscitation with Medical Rehabilitation Courses, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia
| | - Aleksander E. Severin
- Department of Normal Physiology, and Department of Anesthesiology and Resuscitation with Medical Rehabilitation Courses, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia
| | - Ilya V. Borisov
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia
| | - Julia A. Podolskaya
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia
| | - Andrey V. Grechko
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia
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6
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de Veld L, van der Lely N, Hermans BJM, van Hoof JJ, Wong L, Vink AS. QTc prolongation in adolescents with acute alcohol intoxication. Eur J Pediatr 2022; 181:2757-2770. [PMID: 35482092 PMCID: PMC9192465 DOI: 10.1007/s00431-022-04471-2] [Citation(s) in RCA: 2] [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: 11/08/2021] [Revised: 03/30/2022] [Accepted: 04/09/2022] [Indexed: 01/24/2023]
Abstract
In adults, alcohol intoxication is associated with prolongation of the QT interval corrected for heart rate (QTc). The QTc is influenced by age and sex. Although alcohol intoxication is increasingly common in adolescents, there are no data on the prevalence of QTc prolongation in adolescents with alcohol intoxication. This study aimed to determine the prevalence of QTc prolongation in adolescents with alcohol intoxication and identify at-risk adolescents. In this observational study including adolescents aged 10-18 years, heart rate and QT interval were automatically assessed from an electrocardiogram (ECG) at alcohol intoxication using a validated algorithm. The QTc was calculated using both the Bazett formula (QTcB) and Fridericia formula (QTcF). If present, an ECG recorded within 1 year of the date of admission to the emergency department was obtained as a reference ECG. A total of 317 adolescents were included; 13.3% had a QTcB and 7.9% a QTcF longer than the sex- and age-specific 95th-percentile. None of the adolescents had a QTcB or QTcF > 500 ms, but 11.8% of the adolescents with a reference ECG had a QTcB prolongation of > 60 ms, while no adolescents had a QTcF prolongation of > 60 ms. QTc prolongation was mainly attributable to an increase in heart rate rather than QT prolongation, which underlies the differences between QTcB and QTcF. Male sex and hypokalaemia increased the likelihood of QTc prolongation.Conclusion: QTc prolongation was seen in approximately 10% of the adolescents presenting with alcohol intoxication, and although no ventricular arrhythmias were observed in this cohort, QTc prolongation increases the potential for malignant QT-related arrhythmias. Clinicians must be aware of the possibility of QTc prolongation during alcohol intoxication and make an effort to obtain an ECG at presentation, measure the QT interval, and give an adequate assessment of the findings. We advocate admitting adolescents with alcohol intoxication and QTc prolongation. During hospital admission, we recommend limiting exposure to QTc-prolonging medication, increasing potassium levels to a high-normal range (4.5-5.0 mmol/L) and obtaining a reference ECG at discharge.
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Affiliation(s)
- Loes de Veld
- Erasmus School of Health Policy and Management, Erasmus University, Postbus 1738, 3000, Rotterdam, DR, Netherlands. .,Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands.
| | - Nico van der Lely
- Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands ,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ben J. M. Hermans
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Joris J. van Hoof
- Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands
| | - Lichelle Wong
- Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands
| | - Arja Suzanne Vink
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands ,Department of Pediatric Cardiology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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7
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Stoner L, Barone Gibbs B, Meyer ML, Fryer S, Credeur D, Paterson C, Stone K, Hanson ED, Kowalsky RJ, Horiuchi M, Mack CP, Dave G. A Primer on Repeated Sitting Exposure and the Cardiovascular System: Considerations for Study Design, Analysis, Interpretation, and Translation. Front Cardiovasc Med 2021; 8:716938. [PMID: 34485414 PMCID: PMC8415972 DOI: 10.3389/fcvm.2021.716938] [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: 05/29/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022] Open
Abstract
Sedentary behavior, particularly sitting, is ubiquitous in many contemporary societies. This is a major societal concern considering the evidence for a strong association between sitting behavior and cardiovascular disease morbidity and mortality. Unsurprisingly, leading public health agencies have begun to advocate “reduction” in sitting behavior. Though, the guidelines are typically vague and non-specific. The lack of specific guidelines for prolonged sitting is attributable to the absence of available evidence to facilitate guideline development. To inform policy, well-designed randomized controlled trials are required to test the efficacy of specific and translatable sitting reduction strategies. To guide the design of randomized controlled trials, this review postulates that several gaps in the literature first need to be filled. Following a general discussion of the importance of sitting behavior to contemporary societies, each of the following are discussed: (i) acute sitting exposure and systems physiology; (ii) recommendations for a systems physiology toolbox; (iii) study design considerations for acute sitting exposure; and (iv) translation of sitting-focused research.
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Affiliation(s)
- Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Bethany Barone Gibbs
- Department of Health and Human Development and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, United States
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Simon Fryer
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Daniel Credeur
- Department of Biology, Ave Maria University, Ave Maria, FL, United States
| | - Craig Paterson
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Keeron Stone
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Erik D Hanson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Robert J Kowalsky
- Department of Health and Kinesiology, Texas A&M University-Kingsville, Kingsville, TX, United States
| | - Masahiro Horiuchi
- Division of Human Environmental Science, Mount Fuji Research Institute, Yamanashi, Japan
| | - Christopher P Mack
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gaurav Dave
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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8
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Individual changes of central blood pressure in response to upright posture: different hemodynamic phenotypes. J Hypertens 2021; 39:2403-2412. [PMID: 34269331 DOI: 10.1097/hjh.0000000000002965] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Most studies about upright regulation of blood pressure have focused on orthostatic hypotension despite the diverse hemodynamic changes induced by orthostatic challenge. We investigated the effect of passive head-up tilt on aortic blood pressure. METHODS Noninvasive peripheral and central hemodynamics in 613 volunteers without cardiovascular morbidities or medications were examined using pulse wave analysis, whole-body impedance cardiography and heart rate variability analysis. RESULTS In all participants, mean aortic SBP decreased by -4 (-5 to -3) mmHg [mean (95% confidence intervals)] and DBP increased by 6 (5--6) mmHg in response to upright posture. When divided into tertiles according to the supine-to-upright change in aortic SBP, two tertiles presented with a decrease [-15 (-14 to -16) and -4 (-3 to -4) mmHg, respectively] whereas one tertile presented with an increase [+7 (7-- 8) mmHg] in aortic SBP. There were no major differences in demographic characteristics between the tertiles. In regression analysis, the strongest explanatory factors for upright changes in aortic SBP were the supine values of, and upright changes in systemic vascular resistance and cardiac output, and supine aortic SBP. CONCLUSION In participants without cardiovascular disease, the changes in central SBP during orthostatic challenge are not uniform. One-third presented with higher upright than supine aortic SBP with underlying differences in the regulation of systemic vascular resistance and cardiac output. These findings emphasize that resting blood pressure measurements give only limited information about the blood pressure status.
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9
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Myocardial preload alters central pressure augmentation through changes in the forward wave. J Hypertens 2019; 36:544-551. [PMID: 29016531 DOI: 10.1097/hjh.0000000000001583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Augmentation index (AIx) is often used to quantify the contribution of wave reflection to central pulse pressure. Recent studies have challenged this view by showing how contractility-induced changes in the forward pressure wave can markedly impact AIx. We hypothesized that changes in preload will also affect AIx through changes in the forward wave and studied this in two experiments. METHODS Noninvasively obtained aortic pressure was used to study central haemodynamics and wave morphology. In the first experiment, we examined the effects of head-up tilt with and without unilateral thigh cuff in 12 young healthy volunteers (mean age 26 years, 50% men). In the second experiment, we examined the effects of active standing in 31 middle-aged patients (mean age 57 years, 65% men) before and after phlebotomy. RESULTS Head-up tilt or active standing significantly decreased AIx [-17.7 ± 10.4 percentage point (pp) in the young population, -4.7 ± 12.3 pp in the middle-aged population, both P < 0.05]. The fall in AIx was associated with increases in HR, diastolic pressure and systemic vascular resistance and a decrease in stroke volume (all P < 0.05). Inflation of a unilateral thigh cuff reduced the decrease in AIx by 10.7 pp, whereas 500 ml of blood loss augmented the fall in AIx by 5.9 pp (both P < 0.05). The changes in AIx were related to a preload-induced change in forward pressure wave shape (earlier peaking and steeper downstroke). CONCLUSION Next to inotropic and chronotropic effects, preload emerges as another myocardial factor that obscures the relation between wave reflection and AIx.
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10
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Filippini LHPM, Postema PG, Zoubin K, Hermans BJM, Blom NA, Delhaas T, Wilde AAM. The brisk-standing-test for long QT syndrome in prepubertal school children: defining normal. Europace 2019; 20:f108-f112. [PMID: 29036559 DOI: 10.1093/europace/eux259] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 07/10/2017] [Indexed: 12/24/2022] Open
Abstract
Aims Long QT syndrome (LQTS) is associated with malignant arrhythmias and sudden death from birth to advanced age. Prolongation of the QT-interval, may however be concealed on standard electrocardiograms (ECG). The brisk-standing-test (BST) was developed to guide LQTS-diagnosis and treatment in adults. We hypothesized that the BST may be used in prepubertal children to identify LQTS subjects. Accordingly, reference values for the BST should be available to prevent incorrect diagnosis and treatment of LQTS. In this study, we aim to present reference values for prepubertal children. Methods and results Healthy, prepubertal children, aged 7-13 years underwent a standard supine resting ECG and during continuous ECG recording performed a BST. The QT-interval and heart rate corrected QTc were measured during the different BST stages. Fifty-seven children, 29 boys (10.2 ± 1.1 years) and 28 girls (9.9 ± 1.1 years) were included. Baseline characteristics and response to standing were not statistically different for boys and girls: mean supine pre-standing heart rate 74 ± 9 vs. 77 ± 9 bpm, supine pre-standing QTc 406 ± 27 vs. 407 ± 17 ms, maximal heart rate upon standing 109 ± 11 vs. 112 ± 11 bpm, and QTc at maximal heart rate 484 ± 29 vs. 487 ± 35 ms. The QT interval corrected for heart rate-prolongation at maximal tachycardia after standing was 79 ± 26 (19-144) ms, which is significantly longer than previously published values in adults (50± 30 ms). Conclusions The QT interval corrected for heart rate prolongation after brisk standing in healthy prepubertal children is more pronounced than in healthy adults. This finding advocates distinct prepubertal cut-off values because using adult values for prepubertal children would yield false positive results with the risk of incorrect LQTS-diagnosis and overtreatment.
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Affiliation(s)
- L H P M Filippini
- Department of Paediatric Cardiology, Juliana Children's Hospital, Els Borst-Eilers plein 275, 2545 CH, The Hague, The Netherlands
| | - P G Postema
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - K Zoubin
- Department of Paediatric Cardiology, Juliana Children's Hospital, Els Borst-Eilers plein 275, 2545 CH, The Hague, The Netherlands
| | - B J M Hermans
- Department of Biomedical Engineering, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - N A Blom
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.,Department of Paediatric Cardiology, Leiden University Medical Centre, Leiden University Hospital, Leiden, The Netherlands
| | - T Delhaas
- Department of Biomedical Engineering, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A A M Wilde
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
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11
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Stone K, Fryer S, Kelsch E, Burnet K, Zieff G, Faulkner J, Credeur D, Lambrick D, Hanson ED, Stoner L. Validity and reliability of lower-limb pulse-wave velocity assessments using an oscillometric technique. Exp Physiol 2019; 104:765-774. [PMID: 30770607 DOI: 10.1113/ep087444] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/13/2019] [Indexed: 01/12/2023]
Abstract
NEW FINDINGS What is the central question of this study? There is growing interest in the effects of sedentarism on central and peripheral cardiovascular health. To permit further investigation, including larger epidemiological studies, there is a need to identify arterial health assessment tools that are valid (accurate) and reliable (precise), yet practical. What is the main finding and its importance? Lower-limb vascular health (femoral-ankle pulse-wave velocity) can be determined in a supine position with accuracy and precision using an oscillometrically based device. This technology might help to improve our understanding of the pathological mechanisms linking cardiovascular disease to sedentarism, including the interaction between peripheral and central vasculature. ABSTRACT There is a growing interest in the deleterious effects of sedentary behaviour on lower-limb arterial health. To permit further investigation, including larger epidemiological studies, there is a need to identify lower-limb arterial health assessment tools that are valid and reliable, yet simple to administer. In this study, we sought to determine the validity and between-day reliability of femoral-ankle pulse-wave velocity (faPWV) measures obtained using an oscillometrically based device (SphygmocCor XCEL) in supine and seated positions. Doppler ultrasound was used as the criterion. A total of 47 healthy adults were recruited for validity (n = 32) and reliability (n = 15) analyses. Validity was determined by measuring faPWV in seated and supine positions using the XCEL and Doppler ultrasound devices, in a randomized order. Between-day reliability was determined by measuring seated and supine faPWV using the XCEL on three different mornings, separated by a maximum of 7 days. The validity criterion [absolute standard error of estimate (aSEE) < 1.0 m s-1 ] was met in the supine [aSEE = 0.8 m s-1 , 95% confidence interval (CI) 0.4-1.0], but not in the seated (aSEE = 1.2 m s-1 , 95% CI 1.1-1.2) position. Intraclass correlation coefficient (ICC) estimates revealed that the XCEL demonstrated good reliability in the supine position (ICC = 0.83, 95% CI 0.65-0.93), but poor reliability in the seated position (ICC = 0.29, 95% CI 0.23-0.63). The oscillometric XCEL device can be used to determine lower-limb pulse-wave velocity with acceptable validity and reliability in the conventionally recommended supine position, but not in the seated position.
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Affiliation(s)
- Keeron Stone
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Simon Fryer
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Elizabeth Kelsch
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - Kathryn Burnet
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - Gabriel Zieff
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - James Faulkner
- Department of Sport and Exercise, University of Winchester, Winchester, UK
| | - Daniel Credeur
- School of Kinesiology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Danielle Lambrick
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Erik D Hanson
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
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Reliability of pulse waveform separation analysis responses to an orthostatic challenge. Hypertens Res 2018; 41:176-182. [PMID: 29335614 DOI: 10.1038/s41440-017-0005-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/17/2017] [Accepted: 08/04/2017] [Indexed: 11/08/2022]
Abstract
Cardiovascular autonomic nervous system function can be assessed using an orthostatic challenge to induce arterial wave reflection. While arterial reflection is typically estimated using a central augmentation index, a superior estimation can be obtained using pulse wave separation analysis to estimate the aortic backward pressure wave (Pb). However, to be of value in a clinical or research setting, an assessment tool must be precise (reliable). Therefore, this study sought to determine the measurement precision of Pb responses to a modified tilt-table test. Twenty healthy adults (26.4 year (SD 5.2), 24.7 kg/m2 (SD 3.8), 55% female) were tested in a fasted state on three different mornings separated by a maximum of seven days. Pressure waveforms were recorded on the left arm, and aortic waveforms were generated using a generalized transfer function. Subsequently, a physiologic flow waveform was assumed to separate the aortic pressure wave into its forward and timing-independent backward (Pb) components. The criterion intra-class correlation coefficient of ≥0.75 was exceeded at baseline (0.79), following a 5-min tilt (0.75), and following a 5-min recovery from tilt (0.75). The standard error of measurement was 7%. These findings indicate that in a healthy cohort, the Pb response to an orthostatic challenge can be assessed with acceptable precision. The next step is to determine the sensitivity (validity) of this technique in identifying cardiovascular autonomic dysfunction in patient groups.
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Maliha G, Townsend RR. A study of the VaSera arterial stiffness device in US patients. J Clin Hypertens (Greenwich) 2017; 19:661-668. [PMID: 28440017 DOI: 10.1111/jch.12967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/06/2016] [Accepted: 12/11/2016] [Indexed: 12/20/2022]
Abstract
The cardio-ankle vascular index (CAVI) represents a promising index of arterial stiffness. However, neither the CAVI measure nor its measurement device, the VaSera, have undergone general testing in a North American clinical setting. To begin the process of collecting normal values in the United States, we studied 20 male and 28 female volunteers without reported cardiovascular or renal disease and no history of smoking. Their CAVIs, ankle-brachial indices (ABIs), and four-limb blood pressures were measured in three positions: supine, 7° Trendelenburg, and 7° reverse Trendelenburg. In addition, the ABI function was validated against an established ABI measurement technique. Position was found to affect CAVI and other hemodynamic parameters, indicating that CAVI is not robust to slight positional variations. No differences were found in the blood pressure between arms or legs (interbrachial or interankle), supporting recent findings from meta-analyses and studies but contradicting other work. This study represents an early step in bringing the VaSera device and its CAVI measurement into clinical practice.
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Affiliation(s)
- George Maliha
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Raymond R Townsend
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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14
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Stone KJ, Fryer SM, Ryan T, Stoner L. The validity and reliability of continuous-wave near-infrared spectroscopy for the assessment of leg blood volume during an orthostatic challenge. Atherosclerosis 2016; 251:234-239. [DOI: 10.1016/j.atherosclerosis.2016.06.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/23/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
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Kangas P, Tahvanainen A, Tikkakoski A, Koskela J, Uitto M, Viik J, Kähönen M, Kööbi T, Mustonen J, Pörsti I. Increased Cardiac Workload in the Upright Posture in Men: Noninvasive Hemodynamics in Men Versus Women. J Am Heart Assoc 2016; 5:JAHA.115.002883. [PMID: 27329447 PMCID: PMC4937251 DOI: 10.1161/jaha.115.002883] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Men and women differ in the risk of cardiovascular disease, but the underlying mechanisms are not completely understood. We examined possible sex‐related differences in supine and upright cardiovascular regulation. Methods and Results Hemodynamics were recorded from 167 men and 167 women of matching age (≈45 years) and body mass index (≈26.5) during passive head‐up tilt. None had diabetes mellitus or cardiovascular disease other than hypertension or used antihypertensive medication. Whole‐body impedance cardiography, tonometric radial blood pressure, and heart rate variability were analyzed. Results were adjusted for height, smoking, alcohol intake, mean arterial pressure, plasma lipids, and glucose. Supine hemodynamic differences were minor: Men had lower heart rate (−4%) and higher stroke index (+7.5%) than women (P<0.05 for both). Upright systemic vascular resistance was lower (−10%), but stroke index (+15%), cardiac index (+16%), and left cardiac work were clearly higher (+20%) in men than in women (P<0.001 for all). Corresponding results were observed in a subgroup of men and postmenopausal women (n=76, aged >55 years). Heart rate variability analyses showed higher low:high frequency ratios in supine (P<0.001) and upright (P=0.003) positions in men. Conclusions The foremost difference in cardiovascular regulation between sexes was higher upright hemodynamic workload for the heart in men, a finding not explained by known cardiovascular risk factors or hormonal differences before menopause. Heart rate variability analyses indicated higher sympathovagal balance in men regardless of body position. The deviations in upright hemodynamics could play a role in the differences in cardiovascular risk between men and women. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01742702.
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Affiliation(s)
| | - Anna Tahvanainen
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Antti Tikkakoski
- School of Medicine, University of Tampere, Finland Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jenni Koskela
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Marko Uitto
- Department of Electronics and Communication Engineering, Tampere University of Technology, Tampere, Finland
| | - Jari Viik
- Department of Electronics and Communication Engineering, Tampere University of Technology, Tampere, Finland
| | - Mika Kähönen
- School of Medicine, University of Tampere, Finland Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Tiit Kööbi
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jukka Mustonen
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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16
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Tahvanainen AM, Tikkakoski AJ, Koskela JK, Nordhausen K, Viitala JM, Leskinen MH, Kähönen MAP, Kööbi T, Uitto MT, Viik J, Mustonen JT, Pörsti IH. The type of the functional cardiovascular response to upright posture is associated with arterial stiffness: a cross-sectional study in 470 volunteers. BMC Cardiovasc Disord 2016; 16:101. [PMID: 27216309 PMCID: PMC4877753 DOI: 10.1186/s12872-016-0281-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In a cross-sectional study we examined whether the haemodynamic response to upright posture could be divided into different functional phenotypes, and whether the observed phenotypes were associated with known determinants of cardiovascular risk. METHODS Volunteers (n = 470) without medication with cardiovascular effects were examined using radial pulse wave analysis, whole-body impedance cardiography, and heart rate variability analysis. Based on the passive head-up tilt induced changes in systemic vascular resistance and cardiac output, the principal determinants of blood pressure, a cluster analysis was performed. RESULTS The haemodynamic response could be clustered into 3 categories: upright increase in vascular resistance and decrease in cardiac output were greatest in the first (+45 % and -27 %, respectively), smallest in the second (+2 % and -2 %, respectively), and intermediate (+22 % and -13 %, respectively) in the third group. These groups were named as 'constrictor' (n = 109), 'sustainer' (n = 222), and 'intermediate' (n = 139) phenotypes, respectively. The sustainers were characterized by male predominance, higher body mass index, blood pressure, and also by higher pulse wave velocity, an index of large arterial stiffness, than the other groups (p < 0.01 for all). Heart rate variability analysis showed higher supine and upright low frequency/high frequency (LF/HF) ratio in the sustainers than constrictors, indicating increased sympathovagal balance. Upright LF/HF ratio was also higher in the sustainer than intermediate group. In multivariate analysis, independent explanatory factors for higher pulse wave velocity were the sustainer (p < 0.022) and intermediate phenotypes (p < 0.046), age (p < 0.001), body mass index (p < 0.001), and hypertension (p < 0.001). CONCLUSIONS The response to upright posture could be clustered to 3 functional phenotypes. The sustainer phenotype, with smallest upright decrease in cardiac output and highest sympathovagal balance, was independently associated with increased large arterial stiffness. These results indicate an association of the functional haemodynamic phenotype with an acknowledged marker of cardiovascular risk. TRIAL REGISTRATION ClinicalTrials.gov NCT01742702.
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Affiliation(s)
- Anna M Tahvanainen
- School of Medicine, University of Tampere, Tampere, Finland. .,School of Medicine / Internal Medicine, FIN-33014 University of Tampere, Tampere, Finland.
| | | | | | - Klaus Nordhausen
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Jani M Viitala
- School of Medicine, University of Tampere, Tampere, Finland
| | | | - Mika A P Kähönen
- School of Medicine, University of Tampere, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, P.O. Box 2000, Tampere, 33521, Finland
| | - Tiit Kööbi
- Department of Clinical Physiology, Tampere University Hospital, P.O. Box 2000, Tampere, 33521, Finland
| | - Marko T Uitto
- School of Medicine, University of Tampere, Tampere, Finland.,Department of Electronics and Communication Engineering, Tampere University of Technology, BioMediTech, Tampere, Finland
| | - Jari Viik
- Department of Electronics and Communication Engineering, Tampere University of Technology, BioMediTech, Tampere, Finland
| | - Jukka T Mustonen
- School of Medicine, University of Tampere, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, Tampere, 33521, Finland
| | - Ilkka H Pörsti
- School of Medicine, University of Tampere, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, Tampere, 33521, Finland
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Ndayisaba JP, Fanciulli A, Granata R, Duerr S, Hintringer F, Goebel G, Krismer F, Wenning GK. Sex and age effects on cardiovascular autonomic function in healthy adults. Clin Auton Res 2015; 25:317-26. [DOI: 10.1007/s10286-015-0310-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/08/2015] [Indexed: 01/23/2023]
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18
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Stoner L, Bonner C, Credeur D, Lambrick D, Faulkner J, Wadsworth D, Williams MA. Reliability of oscillometric central hemodynamic responses to an orthostatic challenge. Atherosclerosis 2015; 241:761-5. [PMID: 26142686 DOI: 10.1016/j.atherosclerosis.2015.06.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/29/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Monitoring central hemodynamic responses to an orthostatic challenge may provide important insight into autonomic nervous system function. Oscillometric pulse wave analysis devices have recently emerged, presenting clinically viable options for investigating central hemodynamic properties. The purpose of the current study was to determine whether oscillometric pulse wave analysis can be used to reliably (between-day) assess central blood pressure and central pressure augmentation (augmentation index) responses to a 5 min orthostatic challenge (modified tilt-table). METHODS Twenty healthy adults (26.4 y (SD 5.2), 55% F, 24.7 kg/m(2) (SD 3.8)) were tested on 3 different mornings in the fasted state, separated by a maximum of 7 days. Central hemodynamic variables were assessed on the left arm using an oscillometric device. RESULTS Repeated measures analysis of variance indicated a significant main effect of the modified tilt-table for all central hemodynamic variables (P < 0.001). In response to the tilt, central diastolic pressure increased by 4.5 mmHg (CI: 2.6, 6.4), central systolic blood pressure increased by 2.3 (CI: 4.4, 0.16) mmHg, and augmentation index decreased by an absolute - 5.3%, (CI: -2.7, -7.9%). The intra-class correlation coefficient values for central diastolic pressure (0.83-0.86), central systolic blood pressure (0.80-0.87) and AIx (0.79-0.82) were above the 0.75 criterion in both the supine and tilted positions, indicating excellent between-day reliability. CONCLUSION Central hemodynamic responses to an orthostatic challenge can be assessed with acceptable between-day reliability using oscillometric pulse wave analysis.
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Affiliation(s)
- Lee Stoner
- School of Sport and Exercise, Massey University, Wellington, Private Bag 756, Wellington, 6140, New Zealand.
| | - Chantel Bonner
- Department of Epidemiology, Harvard School of Public Health, USA
| | - Daniel Credeur
- School of Human Performance and Recreation, University of Southern Mississippi, USA
| | | | - James Faulkner
- Department of Sport & Exercise, University of Winchester, UK
| | - Daniel Wadsworth
- School of Sport and Exercise, Massey University, Wellington, Private Bag 756, Wellington, 6140, New Zealand
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Vääräniemi K, Koskela J, Tahvanainen A, Tikkakoski A, Wilenius M, Kähönen M, Kööbi T, Niemelä O, Mustonen J, Pörsti I. Lower glomerular filtration rate is associated with higher systemic vascular resistance in patients without prevalent kidney disease. J Clin Hypertens (Greenwich) 2014; 16:722-8. [PMID: 25228202 DOI: 10.1111/jch.12405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 07/29/2014] [Accepted: 07/29/2014] [Indexed: 01/22/2023]
Abstract
The authors examined the association between estimated glomerular filtration rate (eGFR), calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine-cystatin C equation, and hemodynamics in 556 normotensive or never-treated hypertensive patients without kidney disease (mean age, 46 years). Hemodynamic variables were recorded using pulse wave analysis and whole-body impedance cardiography. The mean eGFR was 98 mL/min/1.73 m(2) (range, 64-145 mL/min/1.73 m(2) and one third of the patients had values below 92, while none had proteinuria. In linear regression analyses adjusted for differences in age, weight:height ratio, low-density lipoprotein cholesterol, and sex, significant associations were found between lower eGFR and higher systolic (P=.001) and diastolic blood pressure (P<.001) and higher systemic vascular resistance (P=.001). There was no association between eGFR and cardiac output or extracellular volume. In the absence of clinical kidney disease, lower eGFR was associated with higher blood pressure and systemic vascular resistance. Therefore, early impairment in kidney function may be involved in the pathogenesis of essential hypertension.
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Affiliation(s)
- Kati Vääräniemi
- School of Medicine, University of Tampere, Tampere, Finland; Department of Internal Medicine, Central Hospital of Central Finland, Jyväskylä, Finland
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20
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Trait anxiety mimics age-related cardiovascular autonomic modulation in young adults. J Hum Hypertens 2014; 29:274-80. [DOI: 10.1038/jhh.2014.72] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/25/2014] [Accepted: 07/10/2014] [Indexed: 11/08/2022]
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21
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Hemodynamic alterations in hypertensive patients at rest and during passive head-up tilt. J Hypertens 2013; 31:906-15. [DOI: 10.1097/hjh.0b013e32835ed605] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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22
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Aortic augmentation index and pulse wave velocity in response to head-up tilting: effect of autonomic failure. J Hypertens 2012; 30:307-14. [PMID: 22179089 DOI: 10.1097/hjh.0b013e32834f09ee] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aortic augmentation index (AIx) but not carotid-femoral pulse wave velocity (cfPWV) has reported to decrease in response to vasodilators, which has been related to changes in the timing and/or intensity of wave reflection. Yet, recent evidence indicates that arterial reservoir pressure rather than wave reflection is the most important determinant of AIx. METHODS Using radial artery applanation tonometry and a general transfer function AIx, aortic pulse wave reflection time and cfPWV (foot-to-foot method) were determined in 10 patients with severe autonomic failure and in 14 healthy individuals during supine rest and graded head-up tilting. RESULTS During supine rest, mean blood pressure (BP) (127.6 ± 21.5 and 97.5 ± 9.4 mmHg), AIx (32.4 ± 13.0 and 23.1 ± 8.7%) and cfPWV (12.1 ± 3.6 and 8.9 ± 1.6 m/s) were higher in patients than in controls. In patients, BP decreased by 18.7 ± 9.8 and 39.6 ± 11.7%, AIx by 39.2 ± 27.5 and 100.9 ± 78.1% and cfPWV by 12.0 ± 10.5 and 27.7 ± 13.5% in response to 30 and 60° head-up tilting. Decreases in AIx and cfPWV correlated with the BP fall (r = 0.67, P = 0.001 and r = 0.75, P < 0.001), but changes in AIx and cfPWV were unrelated. In controls, AIx during head-up tilting decreased despite increases in vascular tone and cfPWV. Aortic reflection time in patients and controls during tilting did not change. Stepwise regression analysis revealed that 68% of the variation in AIx could be explained by the BP fall and reflection time and 76% of the variation in cfPWV by the BP fall and sex. CONCLUSION In a clinical model of autonomic failure, both AIx and cfPWV largely depend on instantaneous BP, but these two variables are unrelated, supporting the contention that aortic reservoir pressure rather than wave reflection is the main determinant of AIx.
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Supine and upright haemodynamic effects of sublingual nitroglycerin and inhaled salbutamol. J Hypertens 2012; 30:297-306. [DOI: 10.1097/hjh.0b013e32834e4b26] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Xu K, Butlin M, Avolio AP. Effects of pressure-dependent segmental arterial compliance and postural changes on pulse wave transmission in an arterial model of the human upper limb. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:6450-3. [PMID: 22255815 DOI: 10.1109/iembs.2011.6091592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
With increasing interest in the effect of postural changes on arterial blood pressure and vascular properties, it is important to understand effects of pressure-dependent arterial compliance. This study investigates effects of pressure-dependent compliance on pulse wave velocity (PWVar), pressure wave shape, and transmission characteristics in an arterial model of the human arm from heart to radial artery from supine to standing. Estimated central pressure waveform was used as the input for the model, calculated using a validated transfer function (SphygmoCor, AtCor Medical) from recorded radial pulses in 10 healthy male subjects (53.8 ± 7.9 years) during 0, 30, 60 and 90 degree head-up tilt. A 5-segment linear model was optimized using estimated central and recorded radial arterial pulse; each segment represented by an equivalent inductance, resistance and capacitance (compliance (C)) Pressure-dependent compliance (C(P)=a · e(b · P) was added to develop a nonlinear model, and the radial pulse calculated. Comparison of the radial pulse calculated by the linear and nonlinear models showed no statistical difference in systolic, diastolic, mean, and pulse pressure in any position of tilt. However, waveform shape was increasingly divergent at higher angles of tilt (RMS error 2.3 ± 1.2 mmHg supine, 6.5 ± 3.0 mmHg standing) as was PWVar (0% increase from supine to standing in the linear model, 16.7% increase in nonlinear model). Fourier analysis demonstrated peak amplitude of transmission being at higher frequencies and phase delay being lower in the nonlinear model relative to the linear model. Pressure-dependent arterial compliance, whilst having no effect on peak values of pressure, has significant effects on waveform shape and transmission speed, especially with a more upright position.
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Affiliation(s)
- Ke Xu
- Faculty of Human Science, Australian School of Advanced Medicine, Macquarie University, Sydney, NSW 2109, Australia.
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25
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Davis SCAT, Westerhof BE, van den Bogaard B, Bogert LWJ, Truijen J, Kim YS, Westerhof N, van Lieshout JJ. Active standing reduces wave reflection in the presence of increased peripheral resistance in young and old healthy individuals. J Hypertens 2011; 29:682-9. [PMID: 21330938 DOI: 10.1097/hjh.0b013e328343cda9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pressure wave reflections are age-dependent and generally assumed to increase with increasing peripheral resistance. We sought to determine the effect of standing on wave reflection in healthy older and younger individuals and the influence of increased peripheral resistance. METHODS During supine rest and active standing, continuous finger arterial blood pressure was measured. Data obtained in the supine period and after 1 and 5 min standing were analysed. Aortic pressure and flow, calculated from finger pressure, were used to derive forward and backward pressure waves, reflection magnitude (ratio of backward and forward pressure waves), augmentation index, and peripheral resistance. RESULTS Fifteen healthy older (aged 53±7 years) and 15 healthy younger (aged 29±5 years) individuals were included. In both groups, upon standing, stroke volume, cardiac output and pulse pressure decreased with an increase in heart rate and in diastolic pressure. In the older group peripheral resistance increased from 1.3±0.4 to 1.5±0.4 and 1.5±0.4 for supine, 1 and 5 min standing, whereas reflection magnitude decreased from 0.67±0.1 to 0.61±0.1 and 0.61±0.1, and augmentation index from 33±11 to 23±12 and 25±11. In the younger group peripheral resistance increased from 0.9±0.2 to 1.1±0.2 and 1.1±0.2, whereas reflection magnitude decreased from 0.55±0.05 to 0.48±0.05 and 0.49±0.05 and augmentation index from 18±11 to 1±18 and 4±19. CONCLUSION With standing, haemodynamic variables change similarly in older and younger individuals. The opposite changes in reflection magnitude and peripheral resistance suggest that reflection and pressure augmentation are not solely dependent on peripheral resistance.
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Affiliation(s)
- Shyrin C A T Davis
- Department of Internal Medicine, Laboratory for Clinical Cardiovascular Physiology, Center for Heart Failure Research, University of Amsterdam, The Netherlands
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van den Bogaard B, Westerhof BE, Best H, Davis SCAT, Secher NH, van den Born BJH, van Lieshout JJ. Arterial wave reflection decreases gradually from supine to upright. Blood Press 2011; 20:370-5. [PMID: 21679013 DOI: 10.3109/08037051.2011.588484] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND. An increase in total peripheral resistance (TPR) usually increases arterial wave reflection. During passive head-up tilt (HUT), however, arterial wave reflection decreases with increasing TPR. This study addressed whether arterial wave reflection gradually decreases during HUT. METHODS. In 10 healthy volunteers (22-39 years, nine males), we recorded finger arterial pressures in supine position (0°), and 30°and 70°degrees HUT and active standing (90°). Aortic pressure was constructed from the finger pressure signal and hemodynamics were calculated. Arterial wave reflection was quantified as the augmentation index (AIx) and the reflection magnitude (RM). RESULTS. During HUT, heart rate increased (p < 0.001), stroke volume and cardiac output decreased (p < 0.001 and p < 0.01), diastolic blood pressure increased (p < 0.001), whereas systolic blood pressure did not change. TPR increased from 0.9 dyn s/cm(5) at 0? to 1.2, 1.4 and 1.4 dyn s/cm(5) at 30°, 70° and 90° (p < 0.001). AIx fell gradually from 25% at 0°to 16%, -1% and -10% at 30°, 70° and 90° (p < 0.001). The RM decreased from 0.572 at 0°to 0.456 at 90° (p < 0.001). CONCLUSION. From supine to upright, arterial wave reflection represented as AIx and RM gradually decreases in the presence of increasing TPR.
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Affiliation(s)
- Bas van den Bogaard
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, the Netherlands.
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Philips JC, Marchand M, Scheen AJ. Changes in pulse pressure, heart rate and the pulse pressure x heart rate product during squatting in Type 1 diabetes according to age. Diabet Med 2010; 27:753-61. [PMID: 20636955 DOI: 10.1111/j.1464-5491.2010.03018.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS We assessed changes in pulse pressure and heart rate during a squatting test, as indirect markers of arterial stiffness and cardiovascular autonomic neuropathy, respectively, according to age and sex in patients with Type 1 diabetes mellitus. METHODS We evaluated 160 diabetic patients, divided into four groups of 20 men and 20 women according to age (G1, 20-30 years old; G2, 31-40 years old; G3, 41-50 years old; and G4, 51-60 years old), and 160 non-diabetic matched control subjects. Each subject underwent a 3 min posture test (standing-squatting-standing) with continuous measurement of arterial blood pressure and heart rate by a Finapres device. Overall values throughout the test, baseline levels in initial standing position and squatting-induced changes in pulse pressure, heart rate and the pulse pressure x heart rate product were compared between diabetic patients and healthy control subjects. RESULTS In the standing position, a greater increase in pulse pressure and lower reduction in heart rate with age led to a significantly higher pulse pressure x heart rate product in diabetic patients compared with control subjects. In the squatting position, a more marked pulse pressure increase in the absence of appropriate reduction in heart rate resulted in a greater rise in the pulse pressure x heart rate product in diabetic patients than in healthy subjects. No major differences were noted between the sexes, with the exception of a stronger relationship between pulse pressure and age in the female population with diabetes. Squatting-derived indices of cardiovascular autonomic neuropathy were also noted with increasing age in diabetic patients. CONCLUSIONS The marked increase in the pulse pressure x heart rate product ('pulsatile stress') according to age, combined with cardiovascular autonomic neuropathy, may contribute to the higher cardiovascular risk of patients with Type 1 diabetes.
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Affiliation(s)
- J-C Philips
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Sart Tilman, University of Liège, Liège, Belgium
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