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Sato T, Hanna P, Mori S. Innervation of the coronary arteries and its role in controlling microvascular resistance. J Cardiol 2024; 84:1-13. [PMID: 38346669 DOI: 10.1016/j.jjcc.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 04/08/2024]
Abstract
The coronary circulation plays a crucial role in balancing myocardial perfusion and oxygen demand to prevent myocardial ischemia. Extravascular compressive forces, coronary perfusion pressure, and microvascular resistance are involved to regulate coronary blood flow throughout the cardiac cycle. Autoregulation of the coronary blood flow through dynamic adjustment of microvascular resistance is maintained by complex interactions among mechanical, endothelial, metabolic, neural, and hormonal mechanisms. This review focuses on the neural mechanism. Anatomy and physiology of the coronary arterial innervation have been extensively investigated using animal models. However, findings in the animal heart have limited applicability to the human heart as cardiac innervation is generally highly variable among species. So far, limited data are available on the human coronary artery innervation, rendering multiple questions unresolved. Recently, the clinical entity of ischemia with non-obstructive coronary arteries has been proposed, characterized by microvascular dysfunction involving abnormal vasoconstriction and impaired vasodilation. Thus, measurement of microvascular resistance has become a standard diagnostic for patients without significant stenosis in the epicardial coronary arteries. Neural mechanism is likely to play a pivotal role, supported by the efficacy of cardiac sympathetic denervation to control symptoms in patients with angina. Therefore, understanding the coronary artery innervation and control of microvascular resistance of the human heart is increasingly important for cardiologists for diagnosis and to select appropriate therapeutic options. Advancement in this field can lead to innovations in diagnostic and therapeutic approaches for coronary artery diseases.
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Affiliation(s)
- Takanori Sato
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shumpei Mori
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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2
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Solinsky R, Burns K, Hamner JW, Singer W, Taylor JA. Characterizing preserved autonomic regulation following spinal cord injury: Methods of a novel concerted testing battery and illustrative examples of a new translationally focused data representation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.31.24308290. [PMID: 38854077 PMCID: PMC11160853 DOI: 10.1101/2024.05.31.24308290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Autonomic dysfunction is common after spinal cord injury, though differing from motor and sensory function, there are currently no established batteries of tests to comprehensively characterize these deficits. Further, while individual established autonomic tests have a long history and sound scientific background, translating these autonomic testing results to inform clinical understanding is a major barrier. Herein, we outline a battery of six laboratory autonomic tests which were carefully curated to collectively describe the ability of individuals with spinal cord injury to inhibit and recruit sympathetic activity through the injured spinal cord. Presenting normative control data in 23 uninjured individuals completing this testing battery, we further demonstrate the utility of extracting three key testing metrics for each test, comparing these control results to 11 individuals with spinal cord injury. Results demonstrate strong normality of data with testing psychometrics suggesting reliable reproducibility on repeat testing. Further, even in this preliminary sample of individuals with spinal cord injuries, clear differences begin to emerge. This illustrates the ability of this collective testing battery to characterize autonomic regulation after spinal cord injury. To aid in clinical translation, we further present a graphical representation, an autonomic phenotype, which serves as a snapshot of how normal or abnormal sympathetic inhibition and recruitment of activation may be after spinal cord injury. Utilizing these autonomic phenotypes, three example cases of individuals with spinal cord injury highlight evidence of varied degrees of autonomically complete spinal cord injury. Together, this represents a key advancement in our understanding of autonomic function after spinal cord injury.
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Lee Y, Park D, Kim S, Shin C, Suh S. Association of nightmares with cardio-cerebrovascular disease, hypertension and hyperlipidemia in older adults: A population-based cross-sectional study. J Psychosom Res 2024; 182:111669. [PMID: 38788282 DOI: 10.1016/j.jpsychores.2024.111669] [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: 12/08/2023] [Revised: 04/04/2024] [Accepted: 04/13/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE This cross-sectional study investigated the relationship of nightmares with cardio-cerebrovascular disease (CVD), hypertension and hyperlipidemia which are major preceding diseases of CVD in older adults. METHODS Participants (n = 2824; mean age 63.6 ± 6.6 years, females 49.3%) completed the Disturbing Dream and Nightmare Severity Index (DDNSI), which was used to divide the sample into either the Nightmare or Non-Nightmare group (cut-off score ≥ 10). Demographic information, history of CVD (cerebrovascular disease, myocardial infarction, congestive heart failure, coronary artery disease, and arrhythmia), hypertension, hyperlipidemia, and self-report questionnaires about stress (Perceived Stress Scale), depression (Beck Depression Inventory), sleep quality (Pittsburgh Sleep Quality Index), and insomnia symptoms were also collected. RESULTS Among the sample, 379 participants (13.4%) reported experiencing nightmares more than once a year, and 73 participants (2.6%) were classified as having nightmare disorder based on DDNSI scores (≥10). 11.3% of participants (n = 319) reported having more than one CVD. Approximately half of the participants reported a history of hypertension (52.1%, n = 1471) and hyperlipidemia (47.7%, n = 1346). Logistic regression analysis indicated the Nightmare group was 2.04 times at higher risk for hyperlipidemia (OR = 2.04, 95% CI 1.22-3.40, p = .006) after controlling for covariates compared to the Non-Nightmare group. Although non-significant, there was a trend toward a higher risk of hypertension in the Nightmare group (OR = 1.67, 95% CI 0.99-2.84, p = .056). CONCLUSIONS Results of this study indicate frequent nightmares in older adults may be associated with hyperlipidemia, which are risk factors for CVD. Further studies are needed to explore nightmares' directionality and health consequences in an aging population.
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Affiliation(s)
- Youjin Lee
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea
| | - Dasom Park
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea
| | - Soriul Kim
- Institute of Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Chol Shin
- Institute of Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea; Biomedical Research Center, Korea University Ansan Hospital, Ansan, Gyeonggi, Republic of Korea.
| | - Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea.
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Stavrakis S, Chakraborty P, Farhat K, Whyte S, Morris L, Abideen Asad ZU, Karfonta B, Anjum J, Matlock HG, Cai X, Yu X. Noninvasive Vagus Nerve Stimulation in Postural Tachycardia Syndrome: A Randomized Clinical Trial. JACC Clin Electrophysiol 2024; 10:346-355. [PMID: 37999672 DOI: 10.1016/j.jacep.2023.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/18/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Low-level transcutaneous stimulation of the auricular branch of the vagus nerve at the tragus is antiarrhythmic and anti-inflammatory in animals and humans. Preliminary studies show that transcutaneous vagus nerve stimulation (tVNS) is beneficial in animal models of postural tachycardia syndrome (POTS). OBJECTIVES In this study the authors conducted a sham-controlled, double-blind, randomized clinical trial to examine the effect of tVNS on POTS over a 2-month period relative to sham stimulation. METHODS tVNS (20 Hz, 1 mA below discomfort threshold) was delivered using an ear clip attached to either the tragus (active; n = 12) or the ear lobe (sham; n = 14) for 1 hour daily over a 2-month period. Postural tachycardia was assessed during the baseline and 2-month visit. Heart rate variability based on 5-minute electrocardiogram, serum cytokines, and antiautonomic autoantibodies were measured at the respective time points. RESULTS Mean age was 34 ± 11 years (100% female; 81% Caucasian). Adherence to daily stimulation was 83% in the active arm and 86% in the sham arm (P > 0.05). Postural tachycardia was significantly less in the active arm compared with the sham arm at 2 months (mean postural increase in heart rate 17.6 ± 9.9 beats/min vs 31.7 ± 14.4 beats/min; P = 0.01). Antiadrenergic autoantibodies and inflammatory cytokines were lower in the active arm compared with the sham arm at 2 months (P < 0.05). Heart rate variability was better in the active arm. No device-related side effects were observed. CONCLUSIONS Our results support the emerging paradigm of noninvasive neuromodulation to treat POTS. Mechanistically, this effect appears to be related to reduction of antiautonomic autoantibodies and inflammatory cytokines, and improvement in autonomic tone. Further studies are warranted. (Autoimmune Basis for Postural Tachycardia Syndrome; NCT05043051).
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Affiliation(s)
- Stavros Stavrakis
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | | | - Kassem Farhat
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Seabrook Whyte
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Lynsie Morris
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Brittany Karfonta
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Juvaria Anjum
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - H Greg Matlock
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Xue Cai
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Xichun Yu
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Takahashi N, Kiyota N, Kunikata H, Yamazaki M, Nishimura T, Shiga Y, Aoyagi H, Shidomi M, Tsuda T, Ohtsuka T, Tomida T, Nakazawa T. Vasoreactivity of the optic nerve head, nailfold, and facial skin in response to cold provocation in normal-tension glaucoma patients. BMC Ophthalmol 2023; 23:316. [PMID: 37438715 DOI: 10.1186/s12886-023-03059-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/23/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND The dysfunction of optic nerve head (ONH) hemodynamics has been suggested to be involved in the pathogenesis of normal-tension glaucoma (NTG). The aim of this study was to compare vasoreactivity in the ONH, nailfold, and facial skin in response to cold-water provocation in NTG patients and healthy controls. METHODS We performed cold-water provocation in 14 eyes of 14 NTG patients and 15 eyes of 15 age-matched control subjects. Laser speckle flowgraphy-derived tissue-area mean blur rate (MT), skin blood flowmetry-derived pulse wave amplitude (PA), nailfold capillaroscopy-derived nailfold capillary diameter, and other clinical parameters were recorded at baseline and 4 and 6 min after the cold stimulus. We compared changes (as percentages) in these variables in the NTG and control subjects with a linear mixed-effects model and evaluated correlations between these changes with Spearman's rank correlation coefficient. RESULTS The interaction term between the NTG group (reference, control group) and the 4-min protocol step (reference, baseline) significantly affected the changes in MT, nailfold capillary diameter and PA (β = -9.51%, P = 0.017, β = -20.32%, P = 0.002; β = + 18.06%, P = 0.017, respectively). The change in MT was positively correlated with the change in nailfold capillary diameter, and negatively correlated with the change in PA (r = 0.39, P = 0.036; r = -0.40, P = 0.031, respectively). CONCLUSION NTG patients showed abnormal vasoconstriction in the ONH and nailfold and vasodilation in the facial skin in response to cold-water provocation.
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Affiliation(s)
- Nana Takahashi
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Naoki Kiyota
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Mai Yamazaki
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Seiryo Eye Clinic, Miyagi, Japan
| | - Takayuki Nishimura
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yukihiro Shiga
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hisae Aoyagi
- Department of Health Science Research Planning Division, Rohto Pharmaceutical Co., Ltd, Osaka, Japan
| | - Miwako Shidomi
- Department of Health Science Research Planning Division, Rohto Pharmaceutical Co., Ltd, Osaka, Japan
| | - Tomohiro Tsuda
- Department of Internal Medicine and Food Development Division, Rohto Pharmaceutical Co., Ltd, Osaka, Japan
| | - Toshihiko Ohtsuka
- Department of Advanced Development, Casio Computer Co., Ltd, Tokyo, Japan
| | - Takahiro Tomida
- Department of Advanced Development, Casio Computer Co., Ltd, Tokyo, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Miyagi, Japan.
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Miyagi, Japan.
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan.
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6
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Solinsky R, Schleifer GD, Draghici AE, Hamner JW, Taylor JA. Methodologic implications for rehabilitation research: Differences in heart rate variability introduced by respiration. PM R 2022; 14:1483-1489. [PMID: 35077032 PMCID: PMC9309192 DOI: 10.1002/pmrj.12770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/09/2021] [Accepted: 01/07/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Heart rate variability is a measure of autonomic activity that is growing in popularity as a research outcome. However, despite its increased use, the known effects of respiration on heart rate variability measures are rarely accounted for in rehabilitation medicine research, leading to potential misinterpretation. OBJECTIVE To describe the effect that unpaced and paced breathing introduces to heart rate variability measures in a rehabilitation medicine relevant example of individuals with spinal cord injury. DESIGN Cross-sectional comparison of heart rate variability during unpaced and paced breathing (0.25 Hz, 15 breaths per minute) within the same individuals during the same lab session. SETTING Academic autonomic physiology laboratory. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Mean low frequency (LF) and high frequency (HF) heart rate variability power, percentage of total power derived from the LF spectrum, LF:HF ratio. RESULTS Fifty-nine individuals with spinal cord injury completed laboratory assessments using standardized protocols (NCT02139436). In repeated measures within individuals, mean LF power was significantly higher in unpaced breathing compared to paced breathing (1292 vs. 573 ms2 , p < .001). A Bland-Altman plot demonstrated significant positive proportional bias for LF power when comparing unpaced and paced breathing conditions (R2 = 0.39). Mean HF power was similar between unpaced and paced breathing conditions, although there were wide positive and negative differences between measures, leading to notable uncertainty when respiratory confounders were not accounted for. The percentages of total power derived from the LF spectrum and the mean LF:HF ratio were both significantly higher for unpaced breathing compared to paced breathing (64 vs. 42%, p < .001; and 3.2 vs. 1.1, p < .001, respectively). CONCLUSION Respiration has a significant effect on heart rate variability following spinal cord injury, and not accounting for this has serious consequences for accurate interpretation of unpaced data. Future studies of heart rate variability in rehabilitation medicine should accordingly consider paced breathing.
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Affiliation(s)
- Ryan Solinsky
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
| | | | - Adina E Draghici
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
| | - Jason W Hamner
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
| | - J Andrew Taylor
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
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7
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Mun S, Park S, Whang S, Whang M. Effects of Temporary Respiration Exercise with Individual Harmonic Frequency on Blood Pressure and Autonomic Balance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15676. [PMID: 36497750 PMCID: PMC9736073 DOI: 10.3390/ijerph192315676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
This study investigated the effects of modulated respiration on blood pressure and autonomic balance to develop a healthcare application system for stabilizing autonomic balance. Thirty-two participants were asked to perform self-regulated tasks with 18 different respiration sequences, and their electrocardiograms (ECG) and blood pressure were measured. Changes in cardiovascular system functions and blood pressure were compared between free-breathing and various respiration conditions. Systolic and diastolic blood pressures stabilized after individual harmonic breathing. Autonomic balance, characterized by heart rate variability, was also stabilized with brief respiration training according to harmonic frequency. Five machine-learning algorithms were used to classify the two opposing factors between the free and modulated breathing conditions. The random forest models outperformed the other classifiers in the training data of systolic blood pressure and heart rate variability. The mean areas under the curves (AUCs) were 0.82 for systolic blood pressure and 0.98 for heart rate variability. Our findings lend support that blood pressure and autonomic balance were improved by temporary harmonic frequency respiration. This study provides a self-regulated respiration system that can control and help stabilize blood pressure and autonomic balance, which would help reduce mental stress and enhance human task performance in various fields.
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Affiliation(s)
- Sungchul Mun
- Department of Industrial Engineering, Jeonju Universtiy, Jeonju 55069, Republic of Korea
| | - Sangin Park
- Industry-Academy Cooperation Team, Hanyang University, Seoul 04763, Republic of Korea
| | - Sungyop Whang
- Rotary and Mission Systems, Lockheed Martin, 199 Borton Landing Road, Moorestown, NJ 08054, USA
| | - Mincheol Whang
- Department of Human-Centered Artificial Intelligence, Sangmyung University, Seoul 03016, Republic of Korea
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8
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Pre-competitive anxiety and autonomic responses in professional U-20 futsal players: Effect of the competition phase and game location. Physiol Behav 2022; 254:113903. [PMID: 35810834 DOI: 10.1016/j.physbeh.2022.113903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/01/2022] [Accepted: 05/14/2022] [Indexed: 11/21/2022]
Abstract
The study examined whether pre-competition anxiety and autonomic responses in elite futsal players change across the playoffs at away vs home venues. Heart rate variability, somatic and cognitive anxiety and self-confidence (by CSAI-2R questionnaire) were evaluated in nine male futsal players from a professional U-20 team, before competitive matches at the quarter-final, semi-final and final stages played at home and away venues. Two-way ANOVA for repeated measures was used, considering factor one the game location and factor two the playoff stage, with significance set at p<0.05. Significant effects of the playoff stage were demonstrated in the Mean of HR (F = 4.643; p = 0.014) and SD2 index (F = 14.83; p=<0.001)(quarter versus final). No difference was found for somatic and cognitive anxiety and self-confidence between the two factors. The results suggest that play at the final stage of the playoff, regardless of the game location, may cause higher physiological stress, demonstrated by elevated HR and decrease of SD2 index.
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9
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Daniele A, Lucas SJE, Rendeiro C. Detrimental effects of physical inactivity on peripheral and brain vasculature in humans: Insights into mechanisms, long-term health consequences and protective strategies. Front Physiol 2022; 13:998380. [PMID: 36237532 PMCID: PMC9553009 DOI: 10.3389/fphys.2022.998380] [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: 07/19/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
The growing prevalence of physical inactivity in the population highlights the urgent need for a more comprehensive understanding of how sedentary behaviour affects health, the mechanisms involved and what strategies are effective in counteracting its negative effects. Physical inactivity is an independent risk factor for different pathologies including atherosclerosis, hypertension and cardiovascular disease. It is known to progressively lead to reduced life expectancy and quality of life, and it is the fourth leading risk factor for mortality worldwide. Recent evidence indicates that uninterrupted prolonged sitting and short-term inactivity periods impair endothelial function (measured by flow-mediated dilation) and induce arterial structural alterations, predominantly in the lower body vasculature. Similar effects may occur in the cerebral vasculature, with recent evidence showing impairments in cerebral blood flow following prolonged sitting. The precise molecular and physiological mechanisms underlying inactivity-induced vascular dysfunction in humans are yet to be fully established, although evidence to date indicates that it may involve modulation of shear stress, inflammatory and vascular biomarkers. Despite the steady increase in sedentarism in our societies, only a few intervention strategies have been investigated for their efficacy in counteracting the associated vascular impairments. The current review provides a comprehensive overview of the evidence linking acute and short-term physical inactivity to detrimental effects on peripheral, central and cerebral vascular health in humans. We further examine the underlying molecular and physiological mechanisms and attempt to link these to long-term consequences for cardiovascular health. Finally, we summarize and discuss the efficacy of lifestyle interventions in offsetting the negative consequences of physical inactivity.
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Affiliation(s)
- Alessio Daniele
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Samuel J. E. Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Catarina Rendeiro
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Catarina Rendeiro,
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10
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Tapiainen AA, Zaproudina N, Lipponen JA, Tarvainen MP, Vierola A, Rissanen SM, Karjalainen PA, Närhi M. Autonomic responses to tooth clenching and handgrip test. Acta Odontol Scand 2022; 80:389-395. [PMID: 35062852 DOI: 10.1080/00016357.2022.2027514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim was to study the differences in autonomic nervous system activation between maximal tooth clenching task and handgrip test during and after the tasks. Also, the possible activation of trigeminocardiac reflex during the clenching task was explored. MATERIAL AND METHODS We compared autonomic responses to maximal tooth clenching and handgrip in 28 participants. Responses in heart rate variability, heart rate, and blood pressure were evaluated before, during, and after tests. Although all study participants were considered healthy during recruitment, 14 of them showed painful temporomandibular disorders in the clinical examination, which was taken into account in the analyses. RESULTS Handgrip and tooth clenching caused similar autonomic responses. However, tooth clenching seemed to activate the trigeminocardiac reflex shown as clenching-related vagal activation. The painful signs of temporomandibular disorders may interfere with the heart rate variability both at the baseline and during both tests causing significant variation in them. CONCLUSIONS Both handgrip and tooth clenching affect the autonomic nervous system function. Tooth clenching differs from the handgrip due to trigeminocardiac reflex. Painful signs of temporomandibular disorders are interfering with the results of the tests and maybe underestimated in the studies of autonomic responses to both tasks.
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Affiliation(s)
- Atte A. Tapiainen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Nina Zaproudina
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jukka A. Lipponen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Mika P. Tarvainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, KUH, Kuopio, Finland
| | - Anu Vierola
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Saara M. Rissanen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Pasi A. Karjalainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Matti Närhi
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
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11
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Liu SH, Lo LW, Chou YH, Lin WL, Tsai TY, Cheng WH, Lin YJ, Chang SL, Hu YF, Chung FP, Huang HC, Chen SA. Evidence of Ventricular Arrhythmogenicity and Cardiac Sympathetic Hyperinnervation in Early Cirrhotic Cardiomyopathy. Front Physiol 2021; 12:719883. [PMID: 34955871 PMCID: PMC8692789 DOI: 10.3389/fphys.2021.719883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 11/03/2021] [Indexed: 12/29/2022] Open
Abstract
Cirrhotic cardiomyopathy (CMP) is associated with altered cardiac electrophysiological (EP) properties, which leads to the risk of ventricular arrhythmias (VAs). We aimed to evaluate the EP properties, autonomic, and structural remodeling in a rabbit model with early liver cirrhosis (LC). Twelve rabbits were assigned to the sham and LC groups. The early-stage LC was induced by the ligation of the common bile duct. All rabbits received an EP study, VA inducibility test, myocardial, and liver histology staining. Western blot analyses of protein expression and tyrosine hydroxylase stain for sympathetic nerves were performed. The effective refractory period the LC group was significantly longer than the sham group [i.e., left ventricle (LV) 205.56 ± 40.30 vs. 131.36 ± 7.94 ms; right ventricle (RV) 206.78 ± 33.07 vs. 136.79 ± 15.15 ms; left atrium (LA) 140.56 ± 28.75 vs. 67.71 ± 14.29 ms; and right atrium (RA) 133.78 ± 40.58 vs. 65.43 ± 19.49 ms, all p < 0.01], respectively. The VA inducibility was elevated in the LC group when compared with the sham group (i.e., 21.53 ± 7.71 vs. 7.76 ± 2.44%, p = 0.013). Sympathetic innervation (102/μm2/mm2) was increased in all cardiac chambers of the LC group compared with the sham group (i.e., LV 9.11 ± 4.86 vs. 0.17 ± 0.15, p < 0.01; RV 4.36 ± 4.95 vs. 0.18 ± 0.12, p = 0.026; LA 6.79 ± 1.02 vs. 0.44 ± 0.20, p = 0.018; and RA 15.18 ± 5.12 vs. 0.10 ± 0.07, p = 0.014), respectively. Early LC is presented with an increased ventricular vulnerability, structural heterogeneity, and sympathetic innervation. Close monitoring for fatal arrhythmias is warranted in patients with early stages of LC.
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Affiliation(s)
- Shin-Huei Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Hui Chou
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Lun Lin
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsung-Ying Tsai
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Han Cheng
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hui-Chun Huang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
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12
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Leys F, Wenning GK, Fanciulli A. The role of cardiovascular autonomic failure in the differential diagnosis of α-synucleinopathies. Neurol Sci 2021; 43:187-198. [PMID: 34817726 PMCID: PMC8724069 DOI: 10.1007/s10072-021-05746-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/22/2021] [Indexed: 12/17/2022]
Abstract
The α-synucleinopathies comprise a group of adult-onset neurodegenerative disorders including Parkinson’s disease (PD), multiple system atrophy (MSA), dementia with Lewy bodies (DLB,) and — as a restricted non-motor form — pure autonomic failure (PAF). Neuropathologically, the α-synucleinopathies are characterized by aggregates of misfolded α-synuclein in the central and peripheral nervous system. Cardiovascular autonomic failure is a common non-motor symptom in people with PD, a key diagnostic criterion in MSA, a supportive feature for the diagnosis of DLB and disease-defining in PAF. The site of autonomic nervous system lesion differs between the α-synucleinopathies, with a predominantly central lesion pattern in MSA versus a peripheral one in PD, DLB, and PAF. In clinical practice, overlapping autonomic features often challenge the differential diagnosis among the α-synucleinopathies, but also distinguish them from related disorders, such as the tauopathies or other neurodegenerative ataxias. In this review, we discuss the differential diagnostic yield of cardiovascular autonomic failure in individuals presenting with isolated autonomic failure, parkinsonism, cognitive impairment, or cerebellar ataxia.
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Affiliation(s)
- Fabian Leys
- Division of Neurobiology, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Gregor K Wenning
- Division of Neurobiology, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Alessandra Fanciulli
- Division of Neurobiology, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria.
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13
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Debnath S, Levy TJ, Bellehsen M, Schwartz RM, Barnaby DP, Zanos S, Volpe BT, Zanos TP. A method to quantify autonomic nervous system function in healthy, able-bodied individuals. Bioelectron Med 2021; 7:13. [PMID: 34446089 PMCID: PMC8394599 DOI: 10.1186/s42234-021-00075-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/20/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The autonomic nervous system (ANS) maintains physiological homeostasis in various organ systems via parasympathetic and sympathetic branches. ANS function is altered in common diffuse and focal conditions and heralds the beginning of environmental and disease stresses. Reliable, sensitive, and quantitative biomarkers, first defined in healthy participants, could discriminate among clinically useful changes in ANS function. This framework combines controlled autonomic testing with feature extraction during physiological responses. METHODS Twenty-one individuals were assessed in two morning and two afternoon sessions over two weeks. Each session included five standard clinical tests probing autonomic function: squat test, cold pressor test, diving reflex test, deep breathing, and Valsalva maneuver. Noninvasive sensors captured continuous electrocardiography, blood pressure, breathing, electrodermal activity, and pupil diameter. Heart rate, heart rate variability, mean arterial pressure, electrodermal activity, and pupil diameter responses to the perturbations were extracted, and averages across participants were computed. A template matching algorithm calculated scaling and stretching features that optimally fit the average to an individual response. These features were grouped based on test and modality to derive sympathetic and parasympathetic indices for this healthy population. RESULTS A significant positive correlation (p = 0.000377) was found between sympathetic amplitude response and body mass index. Additionally, longer duration and larger amplitude sympathetic and longer duration parasympathetic responses occurred in afternoon testing sessions; larger amplitude parasympathetic responses occurred in morning sessions. CONCLUSIONS These results demonstrate the robustness and sensitivity of an algorithmic approach to extract multimodal responses from standard tests. This novel method of quantifying ANS function can be used for early diagnosis, measurement of disease progression, or treatment evaluation. TRIAL REGISTRATION This study registered with Clinicaltrials.gov , identifier NCT04100486 . Registered September 24, 2019, https://www.clinicaltrials.gov/ct2/show/NCT04100486 .
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Affiliation(s)
- Shubham Debnath
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Todd J Levy
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Mayer Bellehsen
- Department of Psychiatry, Unified Behavioral Health Center and World Trade Center Health Program, Northwell Health, Bay Shore, NY, USA
| | - Rebecca M Schwartz
- Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Center for Disaster Health, Trauma, and Resilience, New York, NY, USA
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Douglas P Barnaby
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Northwell Health, Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Bruce T Volpe
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Northwell Health, Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Theodoros P Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA.
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14
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Abstract
SUMMARY The autonomic nervous system is a complex neural network that controls several organ systems. Its assessment includes a detailed history of autonomic functions, clinical examination, and autonomic tests. Most widely used is a battery of tests that assess cardiovascular reflex autonomic and sudomotor tests, which include deep breathing (assesses parasympathetic function), Valsalva maneuver, tilt test (both assess parasympathetic and adrenergic functions), and sudomotor testing for the evaluation of postganglionic sudomotor fibers. These basic tests represent a foundation of autonomic testing. Nevertheless, the autonomic nervous system also controls organ systems not directly assessed by basic tests. This review describes a number of auxiliary autonomic tests that can be used in addition to basic autonomic tests or can be used independently to explore particular autonomic functions or to answer a specific clinical question. The auxiliary tests described in this review evaluate cardiovascular, thermoregulatory, gastrointestinal, genitourinary, eye, and exocrine functions. These tests are cold pressor test, sustained handgrip maneuver, reverse tilt test, venoarteriolar reflex, laser Doppler flare imaging, microneurography, neck suction, lower body negative pressure, venous occlusion plethysmography, pharmacologic assessment of postganglionic sympathetic outflow, plasma norepinephrine, sympathetic skin response, video cinefluoroscopic swallowing test, esophageal manometry test, small bowel manometry test, wireless motility capsule test, urodynamic studies, penile plethysmography, intracavernosal papaverine injection, infrared video pupillography, corneal confocal microscopy, pupillary response to dilute pilocarpine and hydroxyamphetamine, Schirmer test, tear osmolarity test, and salivary secretion test. The protocol of each test is described in detail. This review can be used as a quick reference for the auxiliary autonomic tests.
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Affiliation(s)
- Rodrigo C Quispe
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.; and
| | - Peter Novak
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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15
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Exploring Heart Rate Variability as a Biomedical Diagnostic Tool for the Disympathetic Dimension of Eight-Constitution Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6613798. [PMID: 34221081 PMCID: PMC8221872 DOI: 10.1155/2021/6613798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/26/2020] [Accepted: 05/31/2021] [Indexed: 11/17/2022]
Abstract
Background Eight-Constitution Medicine (ECM), an extension of Traditional Korean Medicine, divides the population into eight groups based on their physiological characteristics. ECM divides these eight groups into two larger groups based on autonomic reactivity: the Sympathicotonic group and the Vagotonic group (herein referred to as the Disympathetic Dimension). Heart Rate Variability (HRV) is a widely used biomedical tool to assess cardiac autonomic function. This raises the question of the utility of using HRV to correctly diagnose ECM constitutions. Methods A systematic literature review was conducted to evaluate the correlation between HRV and constitutions in Korean Constitutional Medicine, including Eight-Constitution Medicine (ECM) and Sasang Constitution Medicine (SCM). The articles were obtained from both English (Scopus, PubMed, EMBASE, ProQuest, and Medline) and Korean databases (NDSL and RISS), in addition to Google Scholar, without date restriction. 20 studies met the inclusion criteria, and data were extracted against three aspects: (1) correlation between HRV and constitution, (2) HRV reporting and interpretation, and (3) extraneous factors that were controlled in the studies. Results 386 articles were initially identified, which was reduced to n = 20 studies which met the inclusion criteria. Of these, 19 were SCM studies and 1 was an ECM study. Sample sizes varied from 10 to 8498 men and women, with an age range of 10-80 years. SCM studies explored HRV differences by constitution, measuring HRV at resting, with controlled breathing, before and after acupuncture stimulation, and by other interventions. SCM studies reported either no significant differences (HRV at resting or with controlled breathing studies) or conflicting data (HRV with acupuncture stimulation studies). The single ECM study measured HRV at resting and after acupuncture stimulation but reported no significant differences between the two groups of Sympathicotonia and Vagotonia. Conclusions Due to inconsistencies in study design, study population, and measures of HRV, there was no consistency in the data to support the use of HRV as a biomedical determinant of ECM constitutions.
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16
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Weinstein G, Davis-Plourde K, Beiser AS, Seshadri S. Autonomic Imbalance and Risk of Dementia and Stroke: The Framingham Study. Stroke 2021; 52:2068-2076. [PMID: 33874747 PMCID: PMC8154675 DOI: 10.1161/strokeaha.120.030601] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background and Purpose The autonomic nervous system has been implicated in stroke and dementia pathophysiology. High resting heart rate and low heart rate variability indicate the effect of autonomic imbalance on the heart. We examined the associations of resting heart rate and heart rate variability with incident stroke and dementia in a community-based cohort of middle- and old-aged adults. Methods The study sample included 1581 participants aged >60 years and 3271 participants aged >45 years evaluated for incident dementia and stroke, respectively, who participated in the Framingham Offspring cohort third (1983–1987) examination and had follow-up for neurology events after the seventh (1998–2001) examination. Heart rate variability was assessed through the standard deviation (SD) of normal-to-normal RR intervals and the root mean square of successive differences between normal heartbeats from 2-hour Holter monitor. Participants were followed-up for stroke and dementia incidence from exam 7 to a maximum of 10 years. Cox regression models were used to assess the link of resting heart rate and heart rate variability with stroke and dementia risk while adjusting for potential confounders, and interactions with age and sex were assessed. Results Of the dementia (mean age, 55±6 years, 46% men) and stroke (mean age, 48±9 years, 46% men) samples, 133 and 127 developed dementia and stroke, respectively, during the follow-up. Overall, autonomic imbalance was not associated with dementia risk. However, age modified the associations such that SD of normal-to-normal intervals and root mean square of successive differences were associated with dementia risk in older people (hazard ratio [HR] [95% CI] per 1SD, 0.61 [0.38–0.99] and HR [95% CI] per 1SD, 0.34 [0.15–0.74], respectively). High resting heart rate was associated with increased stroke risk (HR [95% CI] per 10 bpm, 1.18 [1.01–1.39]), and high SD of normal-to-normal intervals was associated with lower stroke risk in men (HR [95% CI] per 1SD, 0.46 [0.26–0.79]) but not women (HR [95% CI] per 1SD, 1.25 [0.88–1.79]; P for interaction=0.003). Conclusions Some measures of cardiac autonomic imbalance may precede dementia and stroke occurrence, particularly in older ages and men, respectively.
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Affiliation(s)
- Galit Weinstein
- School of Public Health, University of Haifa, 3498838 Haifa, Israel
| | - Kendra Davis-Plourde
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- The Framingham Study, Framingham, MA, USA
| | - Alexa S. Beiser
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- The Framingham Study, Framingham, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Sudha Seshadri
- The Framingham Study, Framingham, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
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17
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Moštak I, Višnjić N, Junaković A, Krbot Skorić M, Habek M. Comparison of baroreflex sensitivity indices with standard tests of autonomic nervous system function. J Neurol Sci 2021; 426:117473. [PMID: 33984549 DOI: 10.1016/j.jns.2021.117473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In order to further evaluate clinical usefulness of α- and β-adrenergic components of the baroreflex sensitivity (BRS) index, the aim of this study was to compare them to standardized measures of the autonomic dysfunction. METHODS In 275 participants (mean age 40.57 ± 15.19, range 18 to 89 years, 76.4% females) referred for testing of the autonomic nervous system, α-BRSa, β-BRSa and BRSv were compared to heart rate (HR) and blood pressure (BP) values, adrenergic and cardiovagal indices of the Composite Autonomic Severity Score (CASS) and heart rate variability (HRV) parameters. RESULTS α-BRSa showed statistically significant positive correlation with HR in the supine position and negative with the adrenergic index. β-BRSa showed statistically significant negative correlation with tests for parasympathetic nervous system function. BRSv showed statistically significant negative correlation with all HR and BP parameters and positive with all HRV parameters. In a univariable logistic regression analysis, α-BRSa was a negative predictor (Exp(B) 0.866, 95% CI 0.782-0.959, p = 0.006, respectively) of the pathological adrenergic index. To differentiate between subjects with normal and pathological adrenergic index, the optimal cutoff for α-BRSa was found to be 6.741, which gave a sensitivity of 61.0% and a specificity of 56.0%. CONCLUSION BRSa indices showed a good correlation with standard measures of ANS function. The most promising test was α-BRSa, which performed well as a α adrenergic receptors mediated sympathetic nervous system marker.
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Affiliation(s)
- Ivan Moštak
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Nika Višnjić
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Anamari Junaković
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia
| | - Magdalena Krbot Skorić
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia; Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Mario Habek
- School of Medicine, University of Zagreb, Zagreb, Croatia; University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.
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18
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Bellinger P. Functional Overreaching in Endurance Athletes: A Necessity or Cause for Concern? Sports Med 2021; 50:1059-1073. [PMID: 32064575 DOI: 10.1007/s40279-020-01269-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
There are variable responses to short-term periods of increased training load in endurance athletes, whereby some athletes improve without deleterious effects on performance, while others show diminished exercise performance for a period of days to months. The time course of the decrement in performance and subsequent restoration, or super compensation, has been used to distinguish between the different stages of the fitness-fatigue adaptive continuum termed functional overreaching (FOR), non-functional overreaching (NFOR) or overtraining syndrome. The short-term transient training-induced decrements in performance elicited by increases in training load (i.e. FOR) are thought be a sufficient and necessary component of a training program and are often deliberately induced in training to promote meaningful physiological adaptations and performance super-compensation. Despite the supposition that deliberately inducing FOR in athletes may be necessary to achieve performance super-compensation, FOR has been associated with various negative cardiovascular, hormonal and metabolic consequences. Furthermore, recent studies have demonstrated dampened training and performance adaptations in FOR athletes compared to non-overreached athletes who completed the same training program or the same relative increase in training load. However, this is not always the case and a number of studies have also demonstrated substantial performance super-compensation in athletes who were classified as being FOR. It is possible that there are a number of contextual factors that may influence the metabolic consequences associated with FOR and classifying this training-induced state of fatigue based purely on a decrement in performance may be an oversimplification. Here, the most recent research on FOR in endurance athletes will be critically evaluated to determine (1) if there is sufficient evidence to indicate that inducing a state of FOR is necessary and required to induce a performance super-compensation; (2) the metabolic consequences that are associated with FOR; (3) strategies that may prevent the negative consequences of overreaching.
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Affiliation(s)
- Phillip Bellinger
- Griffith Sports Physiology and Performance, Griffith University, Gold Coast, QLD, Australia. .,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
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19
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Krbot Skorić M, Adamec I, Cifrek M, Habek M. Analysis of Autonomic Nervous System Biosignals. IFMBE PROCEEDINGS 2021:20-27. [DOI: 10.1007/978-3-030-73909-6_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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20
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Raasing LR, Vogels OJ, Veltkamp M, van Swol CF, Grutters JC. Current View of Diagnosing Small Fiber Neuropathy. J Neuromuscul Dis 2021; 8:185-207. [PMID: 33337383 PMCID: PMC8075405 DOI: 10.3233/jnd-200490] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Small fiber neuropathy (SFN) is a disorder of the small myelinated Aδ-fibers and unmyelinated C-fibers [5, 6]. SFN might affect small sensory fibers, autonomic fibers or both, resulting in sensory changes, autonomic dysfunction or combined symptoms [7]. As a consequence, the symptoms are potentially numerous and have a large impact on quality of life [8]. Since diagnostic methods for SFN are numerous and its pathophysiology complex, this extensive review focusses on categorizing all aspects of SFN as disease and its diagnosis. In this review, sensitivity in combination with specificity of different diagnostic methods are described using the areas under the curve. In the end, a diagnostic work-flow is suggested based on different phenotypes of SFN.
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Affiliation(s)
- Lisette R.M. Raasing
- ILD Center of Excellence, Department of Pulmonology,St Antonius Hospital, CM, Nieuwegein, The Netherlands
| | - Oscar J.M. Vogels
- Department of Neurology, St Antonius Hospital, CM, Nieuwegein, The Netherlands
| | - Marcel Veltkamp
- ILD Center of Excellence, Department of Pulmonology,St Antonius Hospital, CM, Nieuwegein, The Netherlands
- Division of Heart and Lungs, University Medical Center Utrecht, CX, Utrecht, The Netherlands
| | | | - Jan C. Grutters
- ILD Center of Excellence, Department of Pulmonology,St Antonius Hospital, CM, Nieuwegein, The Netherlands
- Division of Heart and Lungs, University Medical Center Utrecht, CX, Utrecht, The Netherlands
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21
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Cheshire WP, Freeman R, Gibbons CH, Cortelli P, Wenning GK, Hilz MJ, Spies JM, Lipp A, Sandroni P, Wada N, Mano A, Ah Kim H, Kimpinski K, Iodice V, Idiáquez J, Thaisetthawatkul P, Coon EA, Low PA, Singer W. Electrodiagnostic assessment of the autonomic nervous system: A consensus statement endorsed by the American Autonomic Society, American Academy of Neurology, and the International Federation of Clinical Neurophysiology. Clin Neurophysiol 2020; 132:666-682. [PMID: 33419664 DOI: 10.1016/j.clinph.2020.11.024] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 11/02/2020] [Accepted: 11/28/2020] [Indexed: 12/17/2022]
Abstract
Evaluation of disorders of the autonomic nervous system is both an art and a science, calling upon the physician's most astute clinical skills as well as knowledge of autonomic neurology and physiology. Over the last three decades, the development of noninvasive clinical tests that assess the function of autonomic nerves, the validation and standardization of these tests, and the growth of a large body of literature characterizing test results in patients with autonomic disorders have equipped clinical practice further with a valuable set of objective tools to assist diagnosis and prognosis. This review, based on current evidence, outlines an international expert consensus set of recommendations to guide clinical electrodiagnostic autonomic testing. Grading and localization of autonomic deficits incorporates scores from sympathetic cardiovascular adrenergic, parasympathetic cardiovagal, and sudomotor testing, as no single test alone is sufficient to diagnose the degree or distribution of autonomic failure. The composite autonomic severity score (CASS) is a useful score of autonomic failure that is normalized for age and gender. Valid indications for autonomic testing include generalized autonomic failure, regional or selective system syndromes of autonomic impairment, peripheral autonomic neuropathy and ganglionopathy, small fiber neuropathy, orthostatic hypotension, orthostatic intolerance, syncope, neurodegenerative disorders, autonomic hyperactivity, and anhidrosis.
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Affiliation(s)
- William P Cheshire
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, Florida 32224, USA
| | - Roy Freeman
- Department of Neurology, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts 02215-5400, USA
| | - Christopher H Gibbons
- Department of Neurology, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts 02215-5400, USA
| | - Pietro Cortelli
- DIBINEM - University of Bologna, Bologna, Italy; IRCCS Istituto di Scienze Neurologiche, Bologna, Italy
| | - Gregor K Wenning
- Section of Clinical Neurobiology, Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Max J Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, Erlangen 91054, Germany
| | - Judith M Spies
- Department of Neurology, Level 8 East, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
| | - Axel Lipp
- Park-Klinik Weißensee, Schönstraße 80, Berlin 13086, Germany
| | - Paola Sandroni
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905, USA
| | - Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa 078-8510, Japan
| | - Akiko Mano
- Department of Cardiothoracic Surgery, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-Cho Itabashi-ku, Tokyo 173-0015, Japan
| | - Hyun Ah Kim
- Department of Neurology, Keimyung University Dongsan Hospital, 2800 Dalgubeol Daero, Dalseo-gu, Daegu, South Korea
| | - Kurt Kimpinski
- School of Kinesiology, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, Division of Clinical Neurology, Institute of Neurology, University College London, WC1N 3BG London, United Kingdom
| | - Juan Idiáquez
- Department of Neurologia, Facultad de Medicina, University of Valparaíso, 7 Norte 1122, Valparaíso, 2531094, Chile
| | - Pariwat Thaisetthawatkul
- Department of Neurological Sciences, 988435 University of Nebraska Medical Center, Omaha, Nebraska 68198-8435, USA
| | - Elizabeth A Coon
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905, USA
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905, USA.
| | - Wolfgang Singer
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905, USA.
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22
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Adrenergic hyperactivity: a missing link between multiple sclerosis and cardiovascular comorbidities? Acta Neurol Belg 2020; 120:581-587. [PMID: 30467759 DOI: 10.1007/s13760-018-1051-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
Abstract
The aim of the study is to investigate differences in non-standard adrenergic baroreflex sensitivity (BRS) indices in patients with different phenotypes of multiple sclerosis (pwMS) and healthy controls (HC). Retrospective analysis of types of systolic blood pressure (BP) curves during Valsalva maneuver (VM) [balanced (BAR), augmented (AAR) and suppressed (SAR) autonomic responses] and adrenergic baroreflex sensitivity (BRSa) measured with BRSa1, α-BRSa and β-BRSa in patients with clinically isolated syndrome (CIS), relapsing remitting multiple sclerosis (RRMS), progressive multiple sclerosis (PMS) and HC. We also investigated correlations between BRSa1, α-BRSa, β-BRSa and resting catecholamine levels. pwMS had higher α-BRSa compared to HC (p = 0.02). There was no difference in BRSa1, s and β-BRSa between patients with CIS, RRMS and PMS. There was no association between pwMS and HC, and the type of sBP curve [χ2 = 4.332, p = 0.114]. pwMS and BAR or AAR had higher supine systolic and diastolic BP compared to pwMS and SAR. There was a significant correlation between α-BRSa and upright systolic BP (rp =0.194, p = 0.017), α-BRSa and norepinephrine (rs =0.228, p = 0.021), and BRSa1 and epinephrine (rs = 0.226, p = 0.040). pwMS and HC exhibit different alpha-adrenergic response to Valsalva maneuver. These results may explain the connection between MS and increased cardiovascular risk.
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TREAT AF (Transcutaneous Electrical Vagus Nerve Stimulation to Suppress Atrial Fibrillation): A Randomized Clinical Trial. JACC Clin Electrophysiol 2020; 6:282-291. [PMID: 32192678 DOI: 10.1016/j.jacep.2019.11.008] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study was a sham-controlled, double-blind, randomized clinical trial to examine the effect of chronic low level tragus stimulation (LLTS) in patients with paroxysmal AF. BACKGROUND Low-level transcutaneous electrical stimulation of the auricular branch of the vagus nerve at the tragus (LLTS) acutely suppresses atrial fibrillation (AF) in humans, but the chronic effect remains unknown. METHODS LLTS (20 Hz, 1 mA below the discomfort threshold) was delivered using an ear clip attached to the tragus (active arm) (n = 26) or the ear lobe (sham control arm) (n = 27) for 1 h daily over 6 months. AF burden over 2-week periods was assessed by noninvasive continuous electrocardiogram monitoring at baseline, 3 months, and 6 months. Five-minute electrocardiography and serum were obtained at each visit to measure heart rate variability and inflammatory cytokines, respectively. RESULTS Baseline characteristics were balanced between the 2 groups. Adherence to the stimulation protocol (≤4 sessions lost per month) was 75% in the active arm and 83% in the control arm (p > 0.05). At 6 months, the median AF burden was 85% lower in the active arm compared with the control arm (ratio of medians: 0.15; 95% confidence interval: 0.03 to 0.65; p = 0.011). Tumor necrosis factor-alpha was significantly decreased by 23% in the active group relative to the control group (ratio of medians: 0.77; 95% confidence interval: 0.63 to 0.94; p = 0.0093). Frequency domain indices of heart rate variability were significantly altered with active versus control stimulation (p < 0.01). No device-related side effects were observed. CONCLUSIONS Chronic, intermittent LLTS resulted in lower AF burden than did sham control stimulation, supporting its use to treat paroxysmal AF in selected patients. (Transcutaneous Electrical Vagus Nerve Stimulation to Suppress Atrial Fibrillation [TREAT-AF]; NCT02548754).
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Chen W, Chen Z, Xiang Y, Deng C, Zhang H, Wang J. Simultaneous influence of sympathetic autonomic stress on Schlemm's canal, intraocular pressure and ocular circulation. Sci Rep 2019; 9:20060. [PMID: 31882796 PMCID: PMC6934569 DOI: 10.1038/s41598-019-56562-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/12/2019] [Indexed: 11/09/2022] Open
Abstract
This study aimed to investigate changes in Schlemm's canal, intraocular pressure and ocular blood circulation following the activation of the sympathetic nervous system. Twenty healthy volunteers were enrolled in this study. The cold pressor test (CPT) was adopted. Cross-sectional area of Schlemm's canal (SCAR), superficial and deep retinal vessel densities (s-RVD;d-RVD), pupil diameter (PD), intraocular pressure (IOP), mean ocular perfusion pressure (MOPP) and heart rate variability (HRV) were measured at three time-points: baseline (T0) and 5 min (T1) and 10 min (T2) after the CPT. After cold stimulation, LF/HF index (the ratio of low frenquency and high frenquency) increased significantly. IOP decreased from 16.9 ± 1.9 mmHg at baseline to 16.4 ± 2.7 mmHg at T1 and to 15.2 ± 2.7 mmHg at T2. The nasal cross-sectional area of SCAR (SCAR-n) increased from 6283.9 ± 2696.2 µm2 at baseline to 8392.9 ± 3258.7 µm2 at T1 and to 10422.0 ± 3643.8 µm2 at T2. The temporal cross-sectional area of SCAR (SCAR-t) increased from 6414.5 ± 2218.7 µm2 at baseline to 8610.8 ± 2317.1 µm2 at T1 and to 11544.0 ± 4129.2 µm2 at T2. The expansion of Schlemm's canal was observed after the CPT might be caused by sympathetic nerve stimulation, subsequently leading to decreased IOP.
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Affiliation(s)
- Wei Chen
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiqi Chen
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Xiang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaohua Deng
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Zhang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junming Wang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Cicero CE, Raciti L, Monastero R, Mostile G, Donzuso G, Sciacca G, Luca A, Terravecchia C, Giuliano L, Baschi R, Davì M, Zappia M, Nicoletti A. Cardiovascular autonomic function and MCI in Parkinson's disease. Parkinsonism Relat Disord 2019; 69:55-58. [PMID: 31677456 DOI: 10.1016/j.parkreldis.2019.10.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION dysautonomic dysfunction and cognitive impairment represent the most disabling non-motor features of Parkinson's Disease (PD). Recent evidences suggest the association between Orthostatic Hypotension (OH) and PD-Dementia. However, little is known on the interactions between cardiovascular dysautonomia and Mild Cognitive Impairment (MCI). We aimed to evaluate the association between cardiovascular dysautonomia and MCI in patients with PD. METHODS non-demented PD patients belonging to the PACOS cohort underwent a comprehensive instrumental neurovegetative assessment including the study of both parasympathetic and sympathetic function (30:15 ratio, Expiratory-Inspiratory ratio [E-I] and presence of Orthostatic Hypotension [OH]). Diagnosis of MCI was made according to the MDS criteria level II. RESULTS we enrolled 185 PD patients of whom 102 (55.1%) were men, mean age was 64.6 ± 9.7 years, mean disease duration of 5.6 ± 5.5 years with a mean UPDRS-ME score of 31.7 ± 10.9. MCI was diagnosed in 79 (42.7%) patients. OH was recorded in 52 (28.1%) patients, altered 30:15 ratio was recorded in 39 (24.1%) patients and an altered E-I ratio was found in 24 (19.1%) patients. Presence of MCI was associated with an altered 30:15 ratio (adjOR 2.83; 95%CI 1.25-6.40) but not with an altered E-I ratio, while OH was associated only with the amnestic MCI subgroup (OR 2.43; 95% CI 1.05-5.06). CONCLUSION in our study sample, MCI was mainly associated with parasympathetic dysfunction in PD.
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Affiliation(s)
- Calogero Edoardo Cicero
- Department G.F. Ingrassia, Neuroscience Section, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Loredana Raciti
- Department G.F. Ingrassia, Neuroscience Section, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Roberto Monastero
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via La Loggia 1, 90129, Palermo, Italy
| | - Giovanni Mostile
- Department G.F. Ingrassia, Neuroscience Section, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Giulia Donzuso
- Department G.F. Ingrassia, Neuroscience Section, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Giorgia Sciacca
- Department G.F. Ingrassia, Neuroscience Section, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonina Luca
- Department G.F. Ingrassia, Neuroscience Section, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Claudio Terravecchia
- Department G.F. Ingrassia, Neuroscience Section, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Loretta Giuliano
- Department G.F. Ingrassia, Neuroscience Section, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Roberta Baschi
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via La Loggia 1, 90129, Palermo, Italy
| | - Marco Davì
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via La Loggia 1, 90129, Palermo, Italy
| | - Mario Zappia
- Department G.F. Ingrassia, Neuroscience Section, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Alessandra Nicoletti
- Department G.F. Ingrassia, Neuroscience Section, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
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Yousif D, Bellos I, Penzlin AI, Hijazi MM, Illigens BMW, Pinter A, Siepmann T. Autonomic Dysfunction in Preeclampsia: A Systematic Review. Front Neurol 2019; 10:816. [PMID: 31447757 PMCID: PMC6691156 DOI: 10.3389/fneur.2019.00816] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Preeclampsia (PE) is a major obstetric complication that leads to severe maternal and fetal morbidity. Early detection of preeclampsia can reduce the severity of complications and improve clinical outcomes. It is believed that the autonomic nervous system (ANS) is involved in the pathogenesis of PE. We aimed to review the current literature on the prevalence and nature of ANS dysfunction in women with PE and the possible prognostic value of ANS testing in the early detection of PE. Methods: Literature search was performed using Medline (1966–2018), EMBase (1947–2018), Google Scholar (1970–2018), BIOSIS (1926–2018), Web of science (1900–2018); CINAHL (1937–2018); Cochrane Library, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Methodology Register (1999–2018). Additionally, the reference lists of articles included were screened. Results: A total of 26 studies were included in the present review presenting data of 1,854 pregnant women. Among these women, 453 were diagnosed with PE, 93.6% (424/453) of which displayed autonomic dysfunction. ANS function was assessed by cardiovascular reflex tests (n = 9), heart rate variability (n = 11), cardiac baroreflex gain (n = 5), muscle sympathetic nerve activity (MSNA) (n = 3), and biomarkers of sympathetic activity (n = 4). Overall, 21 studies (80.8%) reported at least one of the following abnormalities in ANS function in women diagnosed with PE compared to healthy pregnant control women: reduced parasympathetic activity (n = 16/21, 76%), increased sympathetic activity (n = 12/20, 60%), or reduced baroreflex gain (n = 4/5, 80%). Some of these studies indicated that pressor and orthostatic stress test may be useful in early pregnancy to help estimate the risk of developing PE. However, autonomic function tests seem not to be able to differentiate between mild and severe PE. Conclusions: Current evidence suggests that autonomic dysfunction is highly prevalent in pre-eclamptic women. Among autonomic functions, cardiovascular reflexes appear to be predominantly affected, seen as reduced cardiac parasympathetic activity and elevated cardiac sympathetic activity. The diagnostic value of autonomic testing in the prediction and monitoring of autonomic failure in pre-eclamptic women remains to be determined.
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Affiliation(s)
- Dalia Yousif
- Division of Healthcare Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ana Isabel Penzlin
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Mido Max Hijazi
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Alexandra Pinter
- Division of Healthcare Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany.,Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Timo Siepmann
- Division of Healthcare Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany.,Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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27
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Galloo X, Abugattas JP, Tijskens M, Dendale P, Varnavas V, Wolf M, De Cocker J, Schwagten B, Sieira J, Ströker E, Chierchia GB, de Asmundis C, De Greef Y. Impact of cryoballoon-guided pulmonary vein isolation on non-invasive autonomic tests in patients with paroxysmal atrial fibrillation. Indian Pacing Electrophysiol J 2019; 19:171-177. [PMID: 31132410 PMCID: PMC6823709 DOI: 10.1016/j.ipej.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/23/2019] [Indexed: 12/20/2022] Open
Abstract
Background Pulmonary vein isolation (PVI) modulates the intrinsic cardiac autonomic nervous system (ANS). We evaluated the impact of PVI on 5 non-invasive autonomic tests. Methods Thirty patients (76% male, mean age 60.37 ± 9.02 years) with paroxysmal atrial fibrillation (AF) underwent cryoballoon-guided PVI. Five autonomic tests were performed 24hrs before and after PVI (N = 30) and repeated after 6months (N = 22). Parasympathetic function was measured by heart rate (HR) variability during deep breathing (E/I ratio, I-E difference), Valsalva maneuver (Valsalva-ratio) and head-up tilt test (30/15 ratio). Sympathetic function was measured by systolic BP response to sustained handgrip and 10’ tilting and by diastolic BP response to cold water. Results 24hrs after PVI, baseline HR increased from 57.93 ± 9.06 bpm to 71.10 ± 12.75 bpm (p < 0.001). At 6 months, baseline HR was lower than immediately post-PVI (62.59 ± 7.89 vs 71.36 ± 13.58 bpm, p = 0.032) but still higher in comparison to pre-PVI (62.59 ± 7.89 vs 57.09 ± 8.80 bpm, p < 0.001). No differences were seen in baseline BP and parasympathetic tests acutely and at 6months. Besides an acute lowering in systolic BP increase during handgrip test, all sympathetic tests remained unchanged. Conclusions An acute HR increase attenuated at 6months and an acute lowered systolic BP response to sustained handgrip were the only changes after cryoballoon-guided PVI. Non-invasive autonomic tests seem therefore not appropriate to evaluate the autonomic modulatory effect of PVI, either due to a too limited sensitivity or a too localized effect of PVI to influence test results.
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Affiliation(s)
- Xavier Galloo
- Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium; Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Juan-Pablo Abugattas
- Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium; Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Paul Dendale
- Heart Center Hasselt and University Faculty of Medicine and Life Sciences, Hasselt, Belgium
| | - Varnavas Varnavas
- Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium; Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Michael Wolf
- Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium
| | | | - Bruno Schwagten
- Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium; Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Yves De Greef
- Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium; Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium.
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28
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Oksanen P, Tulppo MP, Auvinen J, Niemelä M, Jämsä T, Puukka K, Huikuri HV, Korpelainen R, Venojärvi M, Kiviniemi AM. Associations of fitness and physical activity with orthostatic responses of heart rate and blood pressure at midlife. Scand J Med Sci Sports 2019; 29:874-885. [PMID: 30697819 DOI: 10.1111/sms.13398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/23/2019] [Indexed: 11/30/2022]
Abstract
Cardiorespiratory fitness (CRF) and physical activity (PA) are associated with autonomic function, but their associations to orthostatic autonomic responses are unclear in epidemiological setting. We hypothesized that higher CRF and PA would associate with higher immediate vagal responses and lower incidence of adverse findings during orthostatic test. At age of 46, 787 men and 938 women without cardiorespiratory diseases and diabetes underwent an orthostatic test (3-minutes sitting, 3-minutes standing) with recording of RR intervals (RRi) and blood pressure (BP) by finger plethysmography. Acute responses of RRi (30:15 ratio) and BP were calculated. CRF was measured by a submaximal step test and daily amount of moderate-to-vigorous PA (MVPA) for 2 weeks by wrist-worn accelerometer. Lifelong PA was based on questionnaires at ages of 14, 31, and 46. High CRF was significantly associated with higher RRi 30:15 ratio (adjusted standardized β = 0.17, P < 0.001) and milder acute decrease of systolic BP while standing (β = 0.10, P = 0.001), while MVPA was not (β = 0.04 for RRi 30:15 ratio and β = 0.05 for systolic BP acute response). High lifelong PA was significantly associated with higher RRi 30:15 ratio (β = 0.08, P = 0.002) but not with acute systolic BP response. Those in the lowest tertile of CRF had 9.2-fold risk (P = 0.002) of having postural orthostatic tachycardia syndrome compared to more fit. Cardiorespiratory fitness and lifelong physical activity, but not current physical activity, were independently associated with higher cardiac vagal response to orthostasis. The present results underscore the importance fitness and lifelong physical activity in prevention of abnormal autonomic function and related cardiovascular risk.
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Affiliation(s)
- Päivi Oksanen
- Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | - Maisa Niemelä
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Timo Jämsä
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Diagnostic Imaging, Oulu University Hospital, Oulu, Finland
| | - Katri Puukka
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,NordLab Oulu and Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Raija Korpelainen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation, Oulu, Finland
| | - Mika Venojärvi
- Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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de Campos CF, Conceição I, Castro ID, Castro J. Early diagnostic tools in hereditary amyloidosis related to transthyretin (hATTR) V30M autonomic neuropathy. Amyloid 2019; 26:35-36. [PMID: 31343294 DOI: 10.1080/13506129.2019.1582503] [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: 10/26/2022]
Affiliation(s)
- Catarina Falcão de Campos
- a Department of Neurosciences and Mental Health, Division of Neurology, Hospital de Santa Maria - CHLN , Lisbon , Portugal.,b Faculdade de Medicina, Institute of Physiology, Instituto de Medicina Molecular, Universidade de Lisboa , Lisbon , Portugal
| | - Isabel Conceição
- a Department of Neurosciences and Mental Health, Division of Neurology, Hospital de Santa Maria - CHLN , Lisbon , Portugal.,b Faculdade de Medicina, Institute of Physiology, Instituto de Medicina Molecular, Universidade de Lisboa , Lisbon , Portugal
| | - Isabel de Castro
- a Department of Neurosciences and Mental Health, Division of Neurology, Hospital de Santa Maria - CHLN , Lisbon , Portugal.,b Faculdade de Medicina, Institute of Physiology, Instituto de Medicina Molecular, Universidade de Lisboa , Lisbon , Portugal
| | - José Castro
- Department of Neurosciences and Mental Health, Division of Neurology, Hospital de Santa Maria – CHLN, Lisbon, Portugal
- Faculdade de Medicina, Institute of Physiology, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
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30
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Autonomic Neuromodulation Acutely Ameliorates Left Ventricular Strain in Humans. J Cardiovasc Transl Res 2018; 12:221-230. [PMID: 30560316 DOI: 10.1007/s12265-018-9853-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 12/05/2018] [Indexed: 12/13/2022]
Abstract
Low-level transcutaneous vagus nerve stimulation at the tragus (LLTS) is anti-adrenergic. We aimed to evaluate the acute effects of LLTS on left ventricular (LV) function and autonomic tone. Patients with diastolic dysfunction and preserved LV ejection fraction were enrolled in a prospective, randomized, double-blind, 2 × 2 cross-over study. Patients received two separate, 1-h sessions, at least 1 day apart, of active LLTS (20 Hz, 1 mA below the discomfort threshold) and sham stimulation. Echocardiography was performed after LLTS or sham stimulation to assess cardiac function. A 5-min ECG was performed to assess heart rate variability (HRV). Twenty-four patients were enrolled. LV global longitudinal strain improved by 1.8 ± 0.9% during active LLTS compared to sham stimulation (p = 0.001). Relative to baseline, HRV frequency domain components (low frequency, high frequency, and their ratio) were favorably altered after LLTS compared to sham stimulation (all p < 0.05). We concluded that LLTS acutely ameliorates cardiac mechanics by modulating the autonomic tone. Trial registration: NCT02983448.
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Heart rate variability, salivary cortisol and competitive state anxiety responses during pre-competition and pre-training moments. Biol Sport 2018; 36:39-46. [PMID: 30899138 PMCID: PMC6413577 DOI: 10.5114/biolsport.2018.78905] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/26/2018] [Accepted: 07/16/2018] [Indexed: 11/17/2022] Open
Abstract
The study aimed to investigate physiological and psychological states prior to competition and prior to training in three different demanding activities. Eighteen canoe athletes, 18 street runners and 18 jiu-jitsu fighters were included in this study (n=54). The Competitive State Anxiety Inventory-2 (CSAI-2), salivary cortisol and heart rate variability (HRV) were measured at two time points (pre-training and pre-competition). Somatic anxiety (F1,42 = 15.29, p = 0.0003), HRV (F1,42 = 23.24, p < 0.0001) and salivary cortisol (F1,42 = 22.96, p < 0.0001) were significantly greater at the pre-competition measurement point than at the pre-training point, but without a main effect of the type of athlete on these variables. A main effect of the type of athlete was found on somatic anxiety (F2,42 = 6.58, p = 0.0033), cognitive anxiety (F2,42 = 10.69, p = 0.0002) and self-confidence (F2,42 = 5.42, p = 0.0080). Correlations between most CSAI-2 and physiological parameters were not significant (p > 0.05). In conclusion, the results indicated that both emotional indices and psychophysiological indices of stress are higher before competition than before training, with differences between emotional states between these sports. Although correlations between emotional states and psycho-physiological states before competition and before training were largely non-significant, these findings reinforce the importance of psychological monitoring of athletes in association with traditional physiological markers such as cortisol and HRV in sportive training programmes as complementary resources to improve both competition performance and the training routine.
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32
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Gerritsen RJS, Band GPH. Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Front Hum Neurosci 2018; 12:397. [PMID: 30356789 PMCID: PMC6189422 DOI: 10.3389/fnhum.2018.00397] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/14/2018] [Indexed: 12/25/2022] Open
Abstract
Contemplative practices, such as meditation and yoga, are increasingly popular among the general public and as topics of research. Beneficial effects associated with these practices have been found on physical health, mental health and cognitive performance. However, studies and theories that clarify the underlying mechanisms are lacking or scarce. This theoretical review aims to address and compensate this scarcity. We will show that various contemplative activities have in common that breathing is regulated or attentively guided. This respiratory discipline in turn could parsimoniously explain the physical and mental benefits of contemplative activities through changes in autonomic balance. We propose a neurophysiological model that explains how these specific respiration styles could operate, by phasically and tonically stimulating the vagal nerve: respiratory vagal nerve stimulation (rVNS). The vagal nerve, as a proponent of the parasympathetic nervous system (PNS), is the prime candidate in explaining the effects of contemplative practices on health, mental health and cognition. We will discuss implications and limitations of our model.
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Affiliation(s)
- Roderik J. S. Gerritsen
- Institute of Psychology, Cognitive Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Guido P. H. Band
- Institute of Psychology, Cognitive Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
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Adlan AM, Veldhuijzen van Zanten JJCS, Lip GYH, Paton JFR, Kitas GD, Fisher JP. Acute hydrocortisone administration reduces cardiovagal baroreflex sensitivity and heart rate variability in young men. J Physiol 2018; 596:4847-4861. [PMID: 30129666 PMCID: PMC6187027 DOI: 10.1113/jp276644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/14/2018] [Indexed: 12/15/2022] Open
Abstract
KEY POINTS A surge in cortisol during acute physiological and pathophysiological stress may precipitate ventricular arrhythmia and myocardial infarction. Reduced cardiovagal baroreflex sensitivity and heart rate variability are observed during acute stress and are associated with an increased risk of acute cardiac events. In the present study, healthy young men received either a single iv bolus of saline (placebo) or hydrocortisone, 1 week apart, in accordance with a randomized, placebo-controlled, cross-over study design. Hydrocortisone acutely increased heart rate and blood pressure and reduced cardiovagal baroreflex sensitivity and heart rate variability in young men. These findings suggest that, by reducing cardiovagal baroreflex sensitivity and heart rate variability, acute surges in cortisol facilitate a pro-arrhythmic milieu and provide an important mechanistic link between stress and acute cardiac events ABSTRACT: Surges in cortisol concentration during acute stress may increase cardiovascular risk. To better understand the interactions between cortisol and the autonomic nervous system, we determined the acute effects of hydrocortisone administration on cardiovagal baroreflex sensitivity (BRS), heart rate variability (HRV) and cardiovascular reactivity. In a randomized, placebo-controlled, single-blinded cross-over study, 10 healthy males received either a single iv bolus of saline (placebo) or 200 mg of hydrocortisone, 1 week apart. Heart rate (HR), blood pressure (BP) and limb blood flow were monitored 3 h later, at rest and during the sequential infusion of sodium nitroprusside and phenylephrine (modified Oxford Technique), a cold pressor test and a mental arithmetic stress task. HRV was assessed using the square root of the mean of the sum of the squares of differences between successive R-R intervals (rMSSD). Hydrocortisone markedly increased serum cortisol 3 h following infusion and also compared to placebo. In addition, hydrocortisone elevated resting HR (+7 ± 4 beats min-1 ; P < 0.001) and systolic BP (+5 ± 5 mmHg; P = 0.008); lowered cardiovagal BRS [geometric mean (95% confidence interval) 15.6 (11.1-22.1) ms/mmHg vs. 26.2 (17.4--39.5) ms/mmHg, P = 0.011] and HRV (rMSSD 59 ± 29 ms vs. 84 ± 38 ms, P = 0.004) and increased leg vasoconstrictor responses to cold pressor test (Δ leg vascular conductance -45 ± 20% vs. -23 ± 26%; P = 0.023). In young men, an acute cortisol surge is accompanied by increases in HR and BP, as well as reductions in cardiovagal BRS and HRV, potentially providing a pro-arrhythmic milieu that may precipitate ventricular arrhythmia or myocardial infarction and increase cardiovascular risk.
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Affiliation(s)
- Ahmed M Adlan
- College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | | | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Julian F R Paton
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - George D Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, UK
| | - James P Fisher
- College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Krbot Skorić M, Crnošija L, Adamec I, Barun B, Gabelić T, Smoljo T, Stanić I, Pavičić T, Pavlović I, Drulović J, Pekmezović T, Habek M. Autonomic symptom burden is an independent contributor to multiple sclerosis related fatigue. Clin Auton Res 2018; 29:321-328. [PMID: 30209702 DOI: 10.1007/s10286-018-0563-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/30/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate a possible association between autonomic dysfunction and fatigue in people with multiple sclerosis. METHODS In 70 people with multiple sclerosis early in the disease course (51 females, mean age 33.8 ± 9.1), quantitative sudomotor axon reflex tests, cardiovascular reflex tests (heart rate and blood pressure responses to the Valsalva maneuver and heart rate response to deep breathing), and the tilt table test were performed. Participants completed the Composite Autonomic Symptom Score 31, the Modified Fatigue Impact Scale, and the Epworth Sleepiness Scale, as well as the Beck Depression Inventory. Cutoff scores of ≥ 38 or ≥ 45 on the Modified Fatigue Impact Scale were used to stratify patients into a fatigued subgroup (N = 17 or N = 9, respectively). RESULTS We found clear associations between fatigue and scores in subjective tests of the autonomic nervous system: fatigued patients scored significantly worse on Composite Autonomic Symptom Score 31, and there was a strong correlation between the Modified Fatigue Impact Scale and the Composite Autonomic Symptom Score 31 (rs = 0.607, p < 0.001). On the other hand, we found only modest associations between fatigue and scores in objective tests of the autonomic nervous system: there was a clear trend for lower sweating outputs at all measured sites, which reached statistical significance for the distal leg and foot. We found weak correlations between the Modified Fatigue Impact Scale and the Valsalva ratio (rs = - 0.306, p = 0.011), as well as between the Modified Fatigue Impact Scale and quantitative sudomotor axon reflex tests of the forearm, proximal, and distal lower leg (rs = - 0.379, p = 0.003; rs = - 0.356, p = 0.005; and rs = - 0.345, p = 0.006, respectively). A multiple regression model showed that the Composite Autonomic Symptom Score 31, Beck Depression Inventory, and Epworth Sleepiness Scale were independent predictors of fatigue (p = 0.005, p = 0.019, and p = 0.010, respectively). CONCLUSION These results suggest that-even early in the course of the disease-people with multiple sclerosis suffer from objective and subjective impairments of the autonomic nervous system. The results also point to an association between autonomic nervous system impairment and multiple sclerosis related fatigue.
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Affiliation(s)
- Magdalena Krbot Skorić
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Luka Crnošija
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Ivan Adamec
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Barbara Barun
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tereza Gabelić
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Ivan Stanić
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tin Pavičić
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivan Pavlović
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Jelena Drulović
- Clinic of Neurology, CCS, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezović
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mario Habek
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
- School of Medicine, University of Zagreb, Zagreb, Croatia.
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Adamec I, Crnošija L, Junaković A, Krbot Skorić M, Habek M. Progressive multiple sclerosis patients have a higher burden of autonomic dysfunction compared to relapsing remitting phenotype. Clin Neurophysiol 2018; 129:1588-1594. [PMID: 29885648 DOI: 10.1016/j.clinph.2018.05.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To determine autonomic dysfunction (AD) differences in patients with relapsing remitting multiple sclerosis (pwRRMS) and progressive MS (pwPMS). METHODS Composite autonomic scoring scale (CASS) and heart rate variability (HRV) were performed in 40 pwRRMS and 30 pwPMS. RESULTS pwPMS had a significantly higher sudomotor index and total CASS score compared to pwRRMS (p < 0.001 and p < 0.001, respectively). Disease duration positively correlated with sudomotor index and total CASS (rs = 0.409, p < 0.001 and rs = 0.472, p < 0.001, respectively), while the Expanded Disability Status Scale (EDSS) positively correlated with sudomotor index and total CASS (rs = 0.411, p < 0.001 and rs = 0.402, p = 0.001, respectively) in all patients. Type of multiple sclerosis (pwRRMS or pwPMS) corrected for age, sex and disease duration, was a statistically significant predictor of CASS value (B = 1.215, p = 0.019). Compared to pwRRMS, pwPMS had a significantly lower standard deviation of NN intervals (SDNN), low frequency (LF), and high frequency (HF), during both the supine and tilt-up phases (all p-values <0.006). pwPMS had a significantly lower LF/HF (p = 0.008) during tilt-up. CONCLUSION There is a significant difference in autonomic function in pwRRMS and pwPMS; with pwPMS having a higher burden of AD, which is particularly evident for sweating dysfunction. SIGNIFICANCE Further research is needed to establish whether parasympathetic and sudomotor dysfunction may serve as markers of progressive MS.
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Affiliation(s)
- Ivan Adamec
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia
| | - Luka Crnošija
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia
| | - Anamari Junaković
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia
| | - Magdalena Krbot Skorić
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia
| | - Mario Habek
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
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Characterisation of cardiac autonomic function in multiple sclerosis based on spontaneous changes of heart rate and blood pressure. Mult Scler Relat Disord 2018; 22:120-127. [DOI: 10.1016/j.msard.2018.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/08/2018] [Accepted: 03/23/2018] [Indexed: 12/12/2022]
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Eickholt C, Jungen C, Drexel T, Alken F, Kuklik P, Muehlsteff J, Makimoto H, Hoffmann B, Kelm M, Ziegler D, Kloecker N, Willems S, Meyer C. Sympathetic and Parasympathetic Coactivation Induces Perturbed Heart Rate Dynamics in Patients with Paroxysmal Atrial Fibrillation. Med Sci Monit 2018; 24:2164-2172. [PMID: 29641513 PMCID: PMC5910663 DOI: 10.12659/msm.905209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Recent evidence indicates that sympathetic/parasympathetic coactivation (CoA) is causally linked to changes in heart rate (HR) dynamics. Whether this is relevant for patients with atrial fibrillation (AF) is unknown. Material/Methods In patients with paroxysmal AF (n=26) and age-matched controls, (n=10) we investigated basal autonomic outflow and HR dynamics during separate sympathetic (cold hand immersion) and parasympathetic activation (O2-inhalation), as well as during CoA (cold face test). In an additional cohort (n=7), HR response was assessed before and after catheter-based pulmonary vein isolation (PVI). Ultra-high-density endocardial mapping was performed in patients (n=6) before and after CoA. Results Sympathetic activation increased (control: 74±3 vs. 77±3 bpm, p=0.0098; AF: 60±2 vs. 64±2 bpm, p=0.0076) and parasympathetic activation decreased HR (control: 71±3 vs. 69±3 bpm, p=0.0547; AF: 60±1 vs. 58±2 bpm, p<0.0009), while CoA induced a paradoxical HR increase in patients with AF (control: 73±3 vs. 71±3 bpm, p=0.084; AF: 59±2 vs. 61±2 bpm, p=0.0006), which was abolished after PVI. Non-linear parameters of HR variability (SD1) were impaired during coactivation in patients with AF (control: 61±7 vs. 69±6 ms, p=0.042, AF: 44±32 vs. 32±5 ms, p=0.3929). CoA was associated with a shift of the earliest activation site (18±4 mm) of the sinoatrial nodal region, as documented by ultra-high-density mapping (3442±343 points per map). Conclusions CoA perturbs HR dynamics and shifts the site of earliest endocardial activation in patients with paroxysmal AF. This effect is abolished by PVI, supporting the value of emerging methods targeting the intrinsic cardiac autonomic nervous system to treat AF. CoA might be a valuable tool to assess cardiac autonomic function in a clinical setting.
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Affiliation(s)
- Christian Eickholt
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Jungen
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Drexel
- Department of Internal Medicine, Evangelisches Krankenhaus, Duesseldorf, Germany
| | - Fares Alken
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pawel Kuklik
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Muehlsteff
- Philips Research, Patient Care Solutions, Eindhoven, Netherlands
| | - Hisaki Makimoto
- Section for Rhythmology, Department of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Boris Hoffmann
- Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Malte Kelm
- Department of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center and Leibniz Center for Diabetes Research at the Department of Metabolic Diseases, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Nikolaj Kloecker
- Institute for Neural and Sensory Physiology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Stephan Willems
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Meyer
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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NOTAY KARAMBIR, LEE JORDANB, INCOGNITO ANTHONYV, SEED JEREMYD, ARTHURS ADAMA, MILLAR PHILIPJ. Muscle Strength Influences Pressor Responses to Static Handgrip in Men and Women. Med Sci Sports Exerc 2018; 50:778-784. [DOI: 10.1249/mss.0000000000001485] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Liporaci RF, Saad MC, Crescêncio JC, Marques F, Bevilaqua-Grossi D, Gallo-Júnior L. Cardiac and Musculoskeletal Responses to the Effects of Passive and Active Tilt Test in Healthy Subjects. Arq Bras Cardiol 2018. [PMID: 29538526 PMCID: PMC5831305 DOI: 10.5935/abc.20180003] [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] [Indexed: 11/23/2022] Open
Abstract
Background Maintenance of orthostatism requires the interaction of autonomic and muscle
responses for an efficient postural control, to minimize body motion and
facilitate venous return in a common type of syncope called neurocardiogenic
syncope (NCS). Muscle activity in standing position may be registered by
surface electromyography, and body sway confirmed by displacement of the
center of pressure (COP) on a force platform. These peripheral variables
reflect the role of muscles in the maintenance of orthostatism during the
active tilt test, which, compared with muscle activity during the passive
test (head-up tilt test), enables the analyses of electromyographic activity
of these muscles that may anticipate the clinical effects of CNS during
these tests. Objective to evaluate and compare the effects of a standardized protocol of active and
passive tests for CNS diagnosis associated with the effects of Valsalva
maneuver (VM). Methods twenty-thee clinically stable female volunteers were recruited to undergo
both tests. EMG electrodes were placed on muscles involved in postural
maintenance. During the active test, subjects stood on a force platform. In
addition to electromyography and the platform, heart rate was recorded
during all tests. Three VMs were performed during the tests. Results progressive peripheral changes were observed along both tests, more evidently
during the active test. Conclusion the active test detected changes in muscle and cardiovascular responses,
which were exacerbated by the VM.
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Affiliation(s)
| | - Marcelo Camargo Saad
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brazil
| | - Julio César Crescêncio
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brazil
| | - Fabiana Marques
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brazil
| | - Debora Bevilaqua-Grossi
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brazil
| | - Lourenço Gallo-Júnior
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brazil
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Guan L, Collet JP, Mazowita G, Claydon VE. Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability. Front Neurol 2018; 9:90. [PMID: 29556209 PMCID: PMC5844932 DOI: 10.3389/fneur.2018.00090] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 02/08/2018] [Indexed: 12/20/2022] Open
Abstract
Transient ischemic attack (TIA) and minor stroke have high risks of recurrence and deterioration into severe ischemic strokes. Risk stratification of TIA and minor stroke is essential for early effective treatment. Traditional tools have only moderate predictive value, likely due to their inclusion of the limited number of stroke risk factors. Our review follows Hans Selye’s fundamental work on stress theory and the progressive shift of the autonomic nervous system (ANS) from adaptation to disease when stress becomes chronic. We will first show that traditional risk factors and acute triggers of ischemic stroke are chronic and acute stress factors or “stressors,” respectively. Our first review shows solid evidence of the relationship between chronic stress and stroke occurrence. The stress response is tightly regulated by the ANS whose function can be assessed with heart rate variability (HRV). Our second review demonstrates that stress-related risk factors of ischemic stroke are correlated with ANS dysfunction and impaired HRV. Our conclusions support the idea that HRV parameters may represent the combined effects of all body stressors that are risk factors for ischemic stroke and, thus, may be of important predictive value for the risk of subsequent ischemic events after TIA or minor stroke.
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Affiliation(s)
- Ling Guan
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Jean-Paul Collet
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Garey Mazowita
- Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada.,Department of Family and Community Medicine, Providence Healthcare, Vancouver, BC, Canada
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
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Wulsin L, Herman J, Thayer JF. Stress, autonomic imbalance, and the prediction of metabolic risk: A model and a proposal for research. Neurosci Biobehav Rev 2018; 86:12-20. [DOI: 10.1016/j.neubiorev.2017.12.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/07/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022]
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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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Choudhary N, Deepak KK, Chandra PS, Bhatia S, Sagar R, Jaryal AK, Pandey RM, Tripathi M. Comparison of Autonomic Function before and after Surgical Intervention in Patients with Temporal Lobe Epilepsy. J Epilepsy Res 2017; 7:89-98. [PMID: 29344466 PMCID: PMC5767494 DOI: 10.14581/jer.17014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/14/2017] [Indexed: 11/22/2022] Open
Abstract
Background and Purpose Refractory temporal lobe epilepsy (TLE) is commonly associated with imbalances in cardiovascular (CV) parasympathetic and sympathetic functions, which are treated using TLE surgery. We investigated the effect of hemispheric lateralization of seizure foci on autonomic CV functions before and after TLE surgery. Methods The study was conducted on patients with left TLE (LTLE, n = 23) and right TLE (RTLE, n = 30) undergoing unilateral TLE surgery. To assess the autonomic CV functions, changes in the heart rate (ΔHR) and blood pressure (BP) were measured using a standardized battery of autonomic reactivity tests before surgery and at 3 and 6 months after surgery. Results Before surgery, ΔHR and the expiration to inspiration ratio (E:I) during the deep breathing test were higher in the LTLE group than in the RTLE group (both p < 0.001), but both outcomes were comparable between the groups at 3 and 6 months. ΔHR decreased at 3 and 6 months (p < 0.001 and 0.01, respectively) compared with preoperative values. The E:I at 3 months in the LTLE group was lower (p = 0.04) than the preoperative values. Decrease in systolic BP during the head-up tilt test was greater in the LTLE group than in the RTLE group (p = 0.002) before surgery. The maximum increase in diastolic BP during the cold pressor test was lower in the RTLE group at 6 months than that before surgery (p = 0.001) and in the LTLE group (p = 0.002). Conclusions We found that hemispheric lateralization of seizure foci in the temporal lobe had a differential effect on autonomic CV functions before surgery. Before surgery, parasympathetic reactivity was higher in the LTLE group, and sympathetic reactivity was higher in the RTLE group. After surgery, autonomic CV functions were comparable between the groups, suggesting that TLE surgery stabilizes autonomic CV functions.
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Affiliation(s)
- Navita Choudhary
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kishore K Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Poodipedi S Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shalini Bhatia
- Department of Research Support, A.T.Still University, Kirksville, MO, USA
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok K Jaryal
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Cold pressor test in spinal cord injury—revisited. Spinal Cord 2017; 56:528-537. [DOI: 10.1038/s41393-017-0037-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/08/2017] [Accepted: 11/11/2017] [Indexed: 11/08/2022]
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Vazan R, Filcikova D, Mravec B. Effect of the Stroop test performed in supine position on the heart rate variability in both genders. Auton Neurosci 2017; 208:156-160. [DOI: 10.1016/j.autneu.2017.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 09/04/2017] [Accepted: 10/26/2017] [Indexed: 12/17/2022]
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Lado MJ, Cuesta P, García Caballero A, Vila XA. Influence of visual elicitation over emotion regulation: An investigation employing the heart rate variability. J Integr Neurosci 2017; 16:209-226. [PMID: 28891510 DOI: 10.3233/jin-170014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Several works studied the elicitation of emotions through the exposure of individuals to relevant stimuli, using spectral analysis of Heart Rate Variability (HRV) when people are subject to emotional elicitation. If correlation exists between HRV and emotional responses, spectral analysis can be used to study emotion regulation under external stimuli. In this work, we studied the relationship between visual elicitation and emotion regulation, employing HRV. Images (with pleasant, unpleasant and neutral emotional content) were selected from the IAPS (International Affective Picture System) dataset. Ninety-eight participants were enrolled, and subject to view all images, displayed in random order for each participant. Heart rate was recorded during the experiment, and HRV analysis was performed. Spectral values were studied for the different images. The presentation order of images was relevant, mainly when unpleasant images were viewed in first place; this significantly affects HRV values. Spectral values were higher for men, being this difference stronger when pleasant pictures were displayed. Age and gender dependences of spectral indexes were found. The influence of visual elicitation, with different emotional contents, over HRV, was assessed. Results indicate that HRV parameters are affected when individuals are subject to external, emotional-based stimuli.
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Affiliation(s)
- María J Lado
- Department of Computer Science, ESEI, University of Vigo, Campus As Lagoas, 32004 Ourense, Spain
| | - P Cuesta
- Department of Computer Science, ESEI, University of Vigo, Campus As Lagoas, 32004 Ourense, Spain
| | | | - Xosé A Vila
- Department of Computer Science, ESEI, University of Vigo, Campus As Lagoas, 32004 Ourense, Spain
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Vestergaard ET, Cichosz SL, Møller N, Jørgensen JOL, Fleischer J. Short-term acipimox treatment is associated with decreased cardiac parasympathetic modulation. Br J Clin Pharmacol 2017; 83:2671-2677. [PMID: 28736944 DOI: 10.1111/bcp.13384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/02/2017] [Accepted: 07/19/2017] [Indexed: 11/28/2022] Open
Abstract
AIMS The nicotinic acid analogue acipimox is an antilipolytic agent, which acutely inhibits lipolysis and suppresses systemic levels of free fatty acids (FFA) and improves insulin sensitivity in obese patients. These effects of acipimox are transient due to a counter-regulatory increase in growth hormone levels that reverse the antilipolytic effect of acipimox. Hypopituitary patients constitute a viable model to study the growth hormone-independent effects of acipimox and the impact of isolated changes in FFA concentrations and insulin sensitivity on parasympathetic nervous activity. The aim of the present study was to investigate if pharmacological antilipolysis with acipimox acutely affects autonomic tone. METHODS We studied heart rate variability as a measure of autonomic tone in eight hypopituitary men with and without acipimox treatment. The standard deviation of normal-to-normal intervals, root mean square of successive differences and high frequency were measured as heart rate variability parameters. The patients were studied in the basal and insulin-stimulated state with clamped plasma glucose on two occasions in a randomized, double-blind and placebo-controlled crossover study. RESULTS Plasma glucose (4.7 vs. 4.9 mmol l-1 , P = 0.02) and serum FFA (0.05 vs. 0.41 mmol l-1 , P < 0.001) were significantly decreased during acipimox treatment. Acipimox had an inhibitory effect on standard deviation of normal-to-normal intervals (41.3 vs. 45.3 ms, P = 0.01), root mean square of successive differences (23.2 vs. 11 ms, P = 0.03) and high frequency (3.79 vs 3.60 ln (ms2 ), P = 0.02) and these effects were reversed during clamping. CONCLUSIONS Short-term inhibition of lipolysis by acipimox treatment lowered circulating FFA levels, improved insulin sensitivity, and was accompanied by reduced parasympathetic tone. The effect of acipimox on the parasympathetic modulation was reversed by hyperinsulinaemia.
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Affiliation(s)
- Esben Thyssen Vestergaard
- Medical Research Laboratory, Aarhus University, Aarhus, Denmark.,Department of Pediatrics, Randers Regional Hospital, Randers, Denmark
| | - Simon Lebech Cichosz
- Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Niels Møller
- Medical Research Laboratory, Aarhus University, Aarhus, Denmark.,Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Otto Lunde Jørgensen
- Medical Research Laboratory, Aarhus University, Aarhus, Denmark.,Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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48
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Castro P, Freitas J, Santos R, Panerai R, Azevedo E. Indexes of cerebral autoregulation do not reflect impairment in syncope: insights from head-up tilt test of vasovagal and autonomic failure subjects. Eur J Appl Physiol 2017; 117:1817-1831. [PMID: 28681121 DOI: 10.1007/s00421-017-3674-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/26/2017] [Indexed: 12/27/2022]
Abstract
PURPOSE The study of dynamic cerebral autoregulation (CA), which adapts cerebral blood flow to arterial blood pressure (ABP) fluctuations, has been limited in orthostatic intolerance syndromes, mainly due to its stationary prerequisites hardly to meet during maneuvers to provoke syncope itself. New techniques of continuous estimates of CA could overcome this pitfall. We aimed to evaluate CA during head-up tilt test in common conditions causing syncope. METHODS We compared three groups: eight controls; eight patients with autonomic failure due to familial amyloidotic polyneuropathy; eight patients with vasovagal syncope (VVS). ABP and cerebral blood flow velocity (CBFV) were measured with Finometer® and transcranial Doppler. We calculated cerebrovascular resistance index (CVRi), critical closing pressure (CrCP) and resistance area product (RAP), and derived CA continuously from autoregulation index [ARI(t)]. RESULTS With HUTT, AF subjects showed a pronounced decrease in CBFV (-36 ± 17 versus -7 ± 6%, p < 0.0001), ABP (-29 ± 27 versus 7 ± 12%, p < 0.0001) and RAP (-17 ± 23 versus 3 ± 18%, p < 0.0001) but not CVRi (p = 0.110). VVS subjects showed progressive cerebral vasoconstriction prior to syncope, (reduced CBFV 19 ± 15 versus 1 ± 6, p < 0.000; increased RAP 12 ± 18 versus 2 ± 3%, p = 0.024 and CVRi 12 ± 18 versus 2 ± 3%, p = 0.005). ARI(t) increased significantly in AF patients (5.7 ± 1.2 versus 6.9 ± 1.2, p = 0.040) and VVS (5.8 ± 1.2 versus 7.3 ± 1.2, p = 0.015) in response to ABP fall during syncope. CONCLUSIONS Our data suggest that dynamic cerebral autoregulatory response to orthostatic challenge is neither affected by autonomic dysfunction nor in neutrally mediated syncope. This study also emphasizes that RAP + CrCP model is more informative than CVRi, mainly during cerebral vasodilatory response to orthostatic hypotension.
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Affiliation(s)
- Pedro Castro
- Department of Neurology, São João Hospital Center, Faculty of Medicine of University of Porto, Alameda Professor Hernani Monteiro, 4200-319, Porto, Portugal.
| | - João Freitas
- Autonomic Unit, São João Hospital Center, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Rosa Santos
- Department of Neurology, São João Hospital Center, Faculty of Medicine of University of Porto, Alameda Professor Hernani Monteiro, 4200-319, Porto, Portugal
| | - Ronney Panerai
- Department of Cardiovascular Sciences and NIH Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Elsa Azevedo
- Department of Neurology, São João Hospital Center, Faculty of Medicine of University of Porto, Alameda Professor Hernani Monteiro, 4200-319, Porto, Portugal
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49
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Corazza I, Giancaterino S, Barletta G, Cecere A, Guaraldi P, Calandra-Buonaura G, Zannoli R, Cortelli P. Wavelet analysis of the Valsalva maneuver: Methodology validation and application to pathological subjects. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2017.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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50
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Mileva-Popova R, Stoynev N, Belova N. Applanation tonometry for evaluation of the haemodynamic response to the active orthostatic test. Artery Res 2017. [DOI: 10.1016/j.artres.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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