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Respiratory and heart rate dynamics during peripheral chemoreceptor deactivation compared to targeted sympathetic and sympathetic/parasympathetic (co-)activation. Auton Neurosci 2022; 241:103009. [PMID: 35753247 DOI: 10.1016/j.autneu.2022.103009] [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] [Received: 03/10/2022] [Revised: 05/29/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The importance of peripheral chemoreceptors for cardiorespiratory neural control is known for decades. Pure oxygen inhalation deactivates chemoreceptors and increases parasympathetic outflow. However, the relationship between autonomic nervous system (ANS) activation and resulting respiratory as well as heart rate (HR) dynamics is still not fully understood. METHODS In young adults the impact of (1) 100 % pure oxygen inhalation (hyperoxic cardiac chemoreflex sensitivity (CHRS) testing), (2) the cold face test (CFT) and (3) the cold pressor test (CPT) on heart rate variability (HRV), hemodynamics and respiratory rate was investigated in randomized order. Baseline ANS outflow was determined assessing respiratory sinus arrhythmia via deep breathing, baroreflex sensitivity and HRV. RESULTS Baseline ANS outflow was normal in all participants (23 ± 1 years, 7 females, 3 males). Hyperoxic CHRS testing decreased HR (after 60 ± 3 vs before 63 ± 3 min-1, p = 0.004), while increasing total peripheral resistance (1053 ± 87 vs 988 ± 76 dyne*s + m2/cm5, p = 0.02) and mean arterial blood pressure (93 ± 4 vs 91 ± 4 mm Hg, p = 0.02). HRV indicated increased parasympathetic outflow after hyperoxic CHRS testing accompanied by a decrease in respiratory rate (15 ± 1vs 19 ± 1 min-1, p = 0.001). In contrast, neither CFT nor CPT altered the respiratory rate (18 ± 1 vs 18 ± 2 min-1, p = 0.38 and 18 ± 1 vs 18 ± 1 min-1, p = 0.84, respectively). CONCLUSION Changes in HR characteristics during deactivation of peripheral chemoreceptors but not during the CFT and CPT are related with a decrease in respiratory rate. This highlights the need of respiratory rate assessment when evaluating adaptations of cardiorespiratory chemoreceptor control.
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Jungen C, Alken FA, Eickholt C, Scherschel K, Kuklik P, Klatt N, Schwarzl J, Moser J, Jularic M, Akbulak RO, Schaeffer B, Willems S, Meyer C. Respiratory sinus arrhythmia is reduced after pulmonary vein isolation in patients with paroxysmal atrial fibrillation. Arch Med Sci 2019; 16:1022-1030. [PMID: 32863990 PMCID: PMC7444695 DOI: 10.5114/aoms.2019.83883] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/11/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Respiratory sinus arrhythmia (RSA) describes heart rate (HR) changes in synchrony with respiration. It is relevant for exercise capacity and mechanistically linked with the cardiac autonomic nervous system. After pulmonary vein isolation (PVI), the current therapy of choice for patients with paroxysmal atrial fibrillation (AF), the cardiac vagal tone is often diminished. We hypothesized that RSA is modulated by PVI in patients with paroxysmal AF. MATERIAL AND METHODS Respiratory sinus arrhythmia, measured by using a deep breathing test and heart rate variability parameters, was studied in 10 patients (64 ±3 years) with paroxysmal AF presenting in stable sinus rhythm for their first catheter-based PVI. Additionally, heart rate dynamics before and after PVI were studied during sympathetic/parasympathetic coactivation by using a cold-face test. All tests were performed within 24 h before and 48 h after PVI. RESULTS After PVI RSA (E/I difference: 7.9 ±1.0 vs. 3.5 ±0.6 bpm, p = 0.006; E/I ratio: 1.14 ±0.02 vs. 1.05 ±0.01, p = 0.003), heart rate variability (SDNN: 31 ±3 vs. 14 ±3 ms, p = 0.006; RMSSD: 17 ±2 vs. 8 ±2 ms, p = 0.002) and the HR response to sympathetic/parasympathetic coactivation (10.2 ±0.7% vs. 5.7 ±1.1%, p = 0.014) were diminished. The PVI-related changes in RSA correlated with the heart rate change during sympathetic/parasympathetic coactivation before vs. after PVI (E/I difference: r = 0.849, p = 0.002; E/I ratio: r = 0.786, p = 0.007). One patient with vagal driven arrhythmia experienced AF recurrence during follow-up (mean: 6.5 ±0.6 months). CONCLUSIONS Respiratory sinus arrhythmia is reduced after PVI in patients with paroxysmal AF. Our findings suggest that this is related to a decrease in cardiac vagal tone. Whether and how this affects the clinical outcome including exercise capacity need to be determined.
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Affiliation(s)
- Christiane Jungen
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Fares-Alexander Alken
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Scherschel
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pawel Kuklik
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Niklas Klatt
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Schwarzl
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Moser
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ruken Oezge Akbulak
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Schaeffer
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Meyer
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Schulze V, Meyer C, Eickholt C, Sansone R, Keymel S, Heiss C, Rassaf T, Kelm M, Steiner S. Impact of Continuous Positive Airway Pressure on Left Ventricular Systolic Loading and Coronary Flow Reserve in Healthy Young Men. Heart Lung Circ 2017; 27:344-349. [PMID: 28522275 DOI: 10.1016/j.hlc.2017.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/17/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Increased augmentation index (AIx) is accompanied by an elevated cardiovascular risk. A reduction of AIx is known for long-term continuous positive airway pressure (CPAP) therapy. We hypothesised that acute preload and left ventricular workload effects AIx and subendocardial viability ratio (SEVR) as a marker of coronary flow reserve. METHODS Increased augmentation index and central blood pressure parameters were measured by radial artery tonometry in 17 healthy men (32/±6years) at rest and during CPAP ventilation at pressures of 5, 10mbar and after recovery. In a subset of seven individuals, haemodynamic parameters and autonomic function were additionally examined using combined impedance cardiography and continuous noninvasive blood pressure monitoring. RESULTS Continuous positive airway pressure reduced heart rate corrected (AIx@75) (-2.8±8.1 [rest] to -10.7±11.3 [5mbar], p<0.01, to -12.2±10.5% [10mbar], p<0.01) and systolic time integral as a marker of left ventricular workload (2115±231 [rest] to 1978±290 [5mbar], p=0.02 to 1940±218 [10mbar], p<0.01 to 2013±241mmHg/s per min [recovery], p=0.03), while central systolic pressure did not change during CPAP. Total Peripheral Resistance Index increased reaching level of significance at 10mbar CPAP condition (1701±300 [rest] to 1850±301dyn*s*m2/cm5 [10mbar], p=0.04). There was a reversible increase of SEVR under CPAP conditions. CONCLUSIONS Continuous positive airway pressure ventilation acutely reduces AIx, heart rate and left ventricular workload in healthy young men. These effects seem to be mediated by left ventricular filling pressure, workload and reflection wave. Furthermore, we found an increase of subendocardial viability ratio as an indication for a rising coronary flow reserve by CPAP.
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Affiliation(s)
- Volker Schulze
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital, Düsseldorf, Germany
| | - Christian Meyer
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital, Düsseldorf, Germany
| | - Christian Eickholt
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital, Düsseldorf, Germany
| | - Roberto Sansone
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital, Düsseldorf, Germany
| | - Stefanie Keymel
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital, Düsseldorf, Germany
| | - Christian Heiss
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital, Düsseldorf, Germany
| | - Tienush Rassaf
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital, Düsseldorf, Germany
| | - Malte Kelm
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital, Düsseldorf, Germany
| | - Stephan Steiner
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Intensive Care Medicine, St. Vincenz Hospital, Limburg.
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Fromonot J, Chaumet G, Gavarry O, Rostain JC, Lucciano M, Joulia F, Brignole M, Deharo JC, Guieu R, Boussuges A. Hyperoxia Improves Hemodynamic Status During Head-up Tilt Testing in Healthy Volunteers: A Randomized Study. Medicine (Baltimore) 2016; 95:e2876. [PMID: 26937921 PMCID: PMC4779018 DOI: 10.1097/md.0000000000002876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Head-up tilt test is useful for exploring neurally mediated syncope. Adenosine is an ATP derivative implicated in cardiovascular disturbances that occur during head-up tilt test. The aim of the present study was to investigate the impact of hyperoxia on adenosine plasma level and on hemodynamic changes induced by head-up tilt testing.Seventeen healthy male volunteers (mean age 35 ± 11 years) were included in the study. The experiment consisted of 2 head-up tilt tests, 1 session with subjects breathing, through a mask, medical air (FiO2 = 21%) and 1 session with administration of pure oxygen (FiO2 = 100%) in double-blind manner. Investigations included continuous monitoring of hemodynamic data and measurement of plasma adenosine levels.No presyncope or syncope was found in 15 of the 17 volunteers. In these subjects, a slight decrease in systolic blood pressure was recorded during orthostatic stress performed under medical air exposure. In contrast, hyperoxia led to increased systolic blood pressure during orthostatic stress when compared with medical air. Furthermore, mean adenosine plasma levels decreased during hyperoxic exposure before (0.31 ± 0.08 μM) and during head-up tilt test (0.33 ± 0.09 μM) when compared with baseline (0.6 ± 0.1 μM). Adenosine plasma level was unchanged during medical air exposure at rest (0.6 ± 0.1 μM), and slightly decreased during orthostatic stress. In 2 volunteers, the head-up tilt test induced a loss of consciousness when breathing air. In these subjects, adenosine plasma level increased during orthostatic stress. In contrast, during hyperoxic exposure, the head-up tilt test did not induce presyncope or syncope. In these 2 volunteers, biological study demonstrated a decrease in adenosine plasma level at both baseline and during orthostatic stress for hyperoxic exposure compared with medical air.These results suggest that hyperoxia was able to increase blood pressure during head-up tilt test via a decrease in plasma adenosine concentration. Our results also suggest that adenosine receptor antagonists are worth trying in neurocardiogenic syncope.
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Affiliation(s)
- Julien Fromonot
- From the UMR-MD2, Dysoxie Suractivité, Institut de Recherche Biomédicale des Armées (IRBA) & Aix-Marseille Université, Faculté de Médecine Nord, Marseille, France (JF, GC, J-CR, FJ, J-CD, RG, AB); Laboratoire HandiBio EA 4322, Université du Sud Toulon Var, La Garde, France (OG); Laboratoire de biomécanique appliquée, Aix Marseille Université, Faculté de Médecine Nord, Marseille, France (ML); and Department of Cardiology, Arrhythmologic Centre, Ospedali del Tigullio, Lavagna, Italy (MB)
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Meyer C, Mühlsteff J, Drexel T, Eickholt C, Kelm M, Zahiragic L, Ziegler D. POTS following traumatic stress: interacting central and intracardiac neural control? J Diabetes Complications 2015; 29:459-61. [PMID: 25708501 DOI: 10.1016/j.jdiacomp.2015.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 10/24/2022]
Abstract
Cardiovascular autonomic dysfunction is one of the most overlooked complications in patients with diabetes. We report the case of a 19-year-old woman with a 4-year history of diabetes referred due to palpitations and light-headedness following traumatic stress. Rise of heart rate and blood pressure during tilt table testing indicated hyperadrenergic postural orthstatic tachycardia syndrome (POTS). Elevated blood pressure variability, an indirect parameter of increased sympathetic activity, remained almost stable during orthostatic stress. Short-term treatment with ivabradine in combination with psychosocial support alleviated POTS-related symptoms. Our findings suggest that traumatic stress in patients with type 1 diabetes mellitus might translate into disturbed neural heart rate control due to a central, ephemeral alteration in autonomic balance.
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Affiliation(s)
- Christian Meyer
- Department of Cardiology/Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group, University Heart Center, University Hospital Eppendorf, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany; Department of Cardiology, Pulmology and Angiology, Heinrich-Heine-University Duesseldorf, Germany.
| | - Jens Mühlsteff
- Philips Research Europe, Patient Care Solutions, Eindhoven, Netherlands
| | - Thomas Drexel
- Department of Cardiology/Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology/Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group, University Heart Center, University Hospital Eppendorf, Hamburg, Germany; Department of Cardiology, Pulmology and Angiology, Heinrich-Heine-University Duesseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmology and Angiology, Heinrich-Heine-University Duesseldorf, Germany
| | - Lejla Zahiragic
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Duesseldorf, Germany; Department of Metabolic Diseases, Heinrich Heine University Duesseldorf, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Duesseldorf, Germany; Department of Metabolic Diseases, Heinrich Heine University Duesseldorf, Germany
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Meyer C, Carvalho P, Brinkmeyer C, Kelm M, Couceiro R, Mühlsteff J. Wearable sensors in syncope management. Med Sci Monit 2015; 21:276-82. [PMID: 25608536 PMCID: PMC4315629 DOI: 10.12659/msm.892147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Syncope is a common disorder with a lifetime prevalence of about 40%. Implantable cardiac electronic devices, including implantable loop recorders (ILR) and implantable cardioverter-defibrillators (ICD), are well established in syncope management. However, despite the successful use of ILR and ICD, diagnosis and therapy still remain challenging in many patients due to the complex hemodynamic interplay of cardiac and vascular adaptations during impending syncopes. Wearable sensors might overcome some limitations, including misdiagnosis and inappropriate defibrillator shocks, because a variety of physiological measures can now be easily acquired by a single non-invasive device at high signal quality. In neurally-mediated syncope (NMS), which is the most common cause of syncope, advanced signal processing methodologies paved the way to develop devices for early syncope detection. In contrast to the relatively benign NMS, in arrhythmia-related syncopes immediate therapeutical intervention, predominantly by electrical defibrillation, is often mandatory. However, in patients with a transient risk of arrhythmia-related syncope, limitations of ICD therapy might outweigh their potential therapeutic benefits. In this context the wearable cardioverter-defibrillator offers alternative therapeutical options for some high-risk patients. Herein, we review recent evidence demonstrating that wearable sensors might be useful to overcome some limitations of implantable devices in syncope management.
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Affiliation(s)
- Christian Meyer
- Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
| | - Paulo Carvalho
- Department of Informatics Engineering, Science and Technology, Faculty of the University of Coimbra, Coimbra, Portugal
| | - Christoph Brinkmeyer
- Department of Electrophysiology, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Department of Electrophysiology, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Ricardo Couceiro
- Department of Informatics Engineering, Science and Technology, Faculty of the University of Coimbra, Coimbra, Portugal
| | - Jens Mühlsteff
- Research Group 'Patient Care Solutions', Philips Research Europe, Eindhoven, Netherlands
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Orbegozo Cortés D, Puflea F, Donadello K, Taccone FS, Gottin L, Creteur J, Vincent JL, De Backer D. Normobaric hyperoxia alters the microcirculation in healthy volunteers. Microvasc Res 2014; 98:23-8. [PMID: 25433297 DOI: 10.1016/j.mvr.2014.11.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/27/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022]
Abstract
The use of high concentrations of inhaled oxygen has been associated with adverse effects but recent data suggest a potential therapeutic role of normobaric hyperoxia (NH) in sepsis and cerebral ischemia. Hyperoxia may induce vasoconstriction and alter endothelial function, so we evaluated its effects on the microcirculation in 40 healthy adult volunteers using side-stream dark field (SDF) video-microscopy on the sublingual area and near-infrared spectroscopy (NIRS) on the thenar eminence. In a first group of volunteers (n=18), measurements were taken every 30 min: at baseline in air, during NH (close to 100% oxygen via a non-rebreathing mask) and during recovery in air. In a second group (n=22), NIRS measurements were taken in NH or ambient air on two separate days to prevent any potential influence of repeated NIRS measurements. NH significantly decreased the proportion of perfused vessels (PPV) from 92% to 66%, perfused vessel density (PVD) from 11.0 to 7.3 vessels/mm, perfused small vessel density (PSVD) from 9.0 to 5.8 vessels/mm and microvascular flow index (MFI) from 2.8 to 2.0, and increased PPV heterogeneity from 7.5% to 30.4%. Thirty minutes after return to air, PPV, PVD, PSVD and MFI remained partially altered. During NH, NIRS descending slope and NIRS muscle oxygen consumption (VO2) decreased from 8.5 to 7.9%/s and 127 to 103 units, respectively, in the first group and from 10.7 to 9.4%/s and 150 to 115 units in the second group. NH, therefore, alters the microcirculation in healthy subjects, decreasing capillary perfusion and VO2 and increasing the heterogeneity of the perfusion.
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Affiliation(s)
- Diego Orbegozo Cortés
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Florin Puflea
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium; Intensive Care Department, Azienda Ospedaliera Universitaria Integrata (AOUI), Università degli Studi di Verona, Verona, Italy
| | - Katia Donadello
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Leonardo Gottin
- Intensive Care Department, Azienda Ospedaliera Universitaria Integrata (AOUI), Università degli Studi di Verona, Verona, Italy
| | - Jacques Creteur
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniel De Backer
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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Vagal Heart Rate Control in Patients with Atrial Fibrillation: Impact of Tonic Activation of Peripheral Chemosensory Function in Heart Failure. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 755:287-97. [DOI: 10.1007/978-94-007-4546-9_37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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MEYER CHRISTIAN, MORREN GEERT, MUEHLSTEFF JENS, HEISS CHRISTIAN, LAUER THOMAS, SCHAUERTE PATRICK, RASSAF TIENUSH, PURERFELLNER HELMUT, KELM MALTE. Predicting Neurally Mediated Syncope Based on Pulse Arrival Time: Algorithm Development and Preliminary Results. J Cardiovasc Electrophysiol 2011; 22:1042-8. [DOI: 10.1111/j.1540-8167.2011.02030.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rassaf T, Westenfeld R, Balzer J, Lauer T, Merx M, Floege J, Steiner S, Heiss C, Kelm M, Meyer C. Modulation of peripheral chemoreflex by neurohumoral adaptations after kidney transplantation. Eur J Med Res 2011; 15 Suppl 2:83-7. [PMID: 21147628 PMCID: PMC4360365 DOI: 10.1186/2047-783x-15-s2-83] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Peripheral chemoreceptors residing predominantly in the carotid body monitor changes in arterial blood oxygen and are mechanistically linked to the cardiorespiratory control by the autonomic nervous system. Enhanced sympathetic activation is common in end-stage renal disease and kidney transplantation has been shown to improve cardiorespiratory reflex measures of autonomic function. OBJECTIVE The aim of the present study was to test whether improvement in renal function following kidney transplantation is related to an improvement in chemosensory function. METHODS AND RESULTS We compared hyperoxic chemoreflex sensitivity (CHRS) in patients after renal transplantation (RTX) to that in patients on maintenance hemodialysis (HD), and that of age- and gender-matched healthy controls. In addition, we investigated the impact of common confounding factors including pharmacological neurohumoral modulation and diabetes mellitus. The difference in the R-R intervals divided by the difference in the oxygen pressures before and after deactivation of the chemoreceptors by 5-min inhalation of 7 L oxygen was calculated as the hyperoxic CHRS. Autonomic activity was characterized by 24-h time-domain heart rate variability (HRV) parameters. CHRS was improved in RTX patients as compared to HD patients being related to HRV. CHRS was related to the concomitant presence of diabetes and medication with cyclosporine. CONCLUSION Our findings indicate that chemosensory activity following kidney transplantation is related to cardiac autonomic control, but functional testing might only be useful to characterize the time course and extent of sympathetic activation in selected patients due to existing co-morbidities and immunosuppressive medication in this population.
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Affiliation(s)
- T Rassaf
- Heinrich-Heine-University Duesseldorf, Department of Medicine, Moorenstr. 5, 40225 Duesseldorf, Germany
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Sympathetic hyperactivity influences chemosensor function in patients with end-stage renal disease. Eur J Med Res 2010; 14 Suppl 4:151-5. [PMID: 20156747 PMCID: PMC3521372 DOI: 10.1186/2047-783x-14-s4-151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Autonomic neuropathy is common in patients suffering from end-stage renal disease (ESRD). This may in part explain the high cardiovascular mortality in these patients. Chemosensory function is involved in autonomic cardiovascular control and is mechanistically linked to the sympathetic tone. Objective The aim of the present study was to assess whether sympathetic hyperactivity contributes to an altered chemosensory function in ESRD. Materials and methods In a randomized, double-masked, placebo controlled crossover design we studied the impact of chemosensory deactivation on heart rate, blood pressure and oxygen saturation in 10 ESRD patients and 10 age and gender matched controls. The difference in the R-R intervals divided by the difference in the oxygen pressures before and after deactivation of the chemoreceptors by 5-min inhalation of 7 L oxygen was calculated as the hyperoxic chemoreflex sensitivity (CHRS). Placebo consisted of breathing room air. Baseline sympathetic activity was characterized by plasma catecholamine levels and 24-h time-domain heart rate variability (HRV) parameters. Results Plasma norepinephrine levels were increased (1.6 ± 0.4 vs. 5.8 ± 0.6; P < 0.05) while the SDNN (standard deviation of all normal R-R intervals: 126.4 ± 19 vs. 100.2 ± 12 ms), the RMSSD (square root of the mean of the squared differences between adjacent normal R-R intervals: 27.1 ± 8 vs. 15.7 ± 2 ms), and the 24-h triangular index (33.6 ± 4 vs. 25.7 ± 3; each P < 0.05) were decreased in ESRD patients as compared to controls. CHRS was impaired in ESRD patients (2.9 ± 0.9 ms/mmHg, P < 0.05) as compared to controls (7.9 ± 1.4 ms/mmHg). On multiple regression analysis 24 h-Triangular index, RMSSD, and plasma norepinephrine levels were independent predictors of an impaired hyperoxic CHRS. Conclusion Sympathetic hyperactivity influences chemosensory function in ESRD resulting in an impaired hyperoxic CHRS.
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