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Mensinger JL, Weissinger GM, Cantrell MA, Baskin R, George C. A Pilot Feasibility Evaluation of a Heart Rate Variability Biofeedback App to Improve Self-Care in COVID-19 Healthcare Workers. Appl Psychophysiol Biofeedback 2024; 49:241-259. [PMID: 38502516 PMCID: PMC11101559 DOI: 10.1007/s10484-024-09621-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
COVID-19 exacerbated burnout and mental health concerns among the healthcare workforce. Due to high work stress, demanding schedules made attuned eating behaviors a particularly challenging aspect of self-care for healthcare workers. This study aimed to examine the feasibility and acceptability of a heart rate variability biofeedback (HRVB) mobile app for improving well-being among healthcare workers reporting elevated disordered eating during COVID-19. We conducted a mixed methods pre-mid-post single-arm pilot feasibility trial (ClinicalTrials.gov NCT04921228). Deductive content analysis of participants' commentary generated qualitative themes. Linear mixed models were used to examine changes in pre- mid- to post-assessment scores on well-being outcomes. We consented 28 healthcare workers (25/89% female; 23/82% Non-Hispanic White; 22/79% nurses) to use and evaluate an HRVB mobile app. Of these, 25/89% fully enrolled by attending the app and device training; 23/82% were engaged in all elements of the protocol. Thirteen (52%) completed at least 10 min of HRVB on two-thirds or more study days. Most participants (18/75%) reported being likely or extremely likely to continue HRVB. Common barriers to engagement were busy schedules, fatigue, and technology difficulties. However, participants felt that HRVB helped them relax and connect better to their body's signals and experiences. Results suggested preliminary evidence of efficacy for improving interoceptive sensibility, mindful self-care, body appreciation, intuitive eating, stress, resilience, and disordered eating. HRVB has potential as a low-cost adjunct tool for enhancing well-being in healthcare workers through positively connecting to the body, especially during times of increased stress when attuned eating behavior becomes difficult to uphold.
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Affiliation(s)
- Janell L Mensinger
- Department of Clinical and School Psychology, College of Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL, 33314, USA.
- Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA.
| | - Guy M Weissinger
- Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Mary Ann Cantrell
- Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Rachel Baskin
- Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Cerena George
- Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
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2
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Dąbrowska E, Narkiewicz K. Hypertension and Dyslipidemia: the Two Partners in Endothelium-Related Crime. Curr Atheroscler Rep 2023; 25:605-612. [PMID: 37594602 PMCID: PMC10471742 DOI: 10.1007/s11883-023-01132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE OF REVIEW The goal of this article is to characterize the endothelium's role in the development of hypertension and dyslipidemia and to point out promising therapeutic directions. RECENT FINDINGS Dyslipidemia may facilitate the development of hypertension, whereas the collaboration of these two silent killers potentiates the risk of atherosclerosis. The common pathophysiological denominator for hypertension and dyslipidemia is endothelial cell dysfunction, which manifests as dysregulation of homeostasis, redox balance, vascular tone, inflammation, and thrombosis. Treatment focused on mediators acting in these processes might be groundbreaking. Metabolomic research on hypertension and dyslipidemia has revealed new therapeutic targets. State-of-the-art solutions integrating interview, clinical examination, innovative imaging, and omics profiles along with artificial intelligence have been already shown to improve patients' risk stratification and treatment. Pathomechanisms underlying hypertension and dyslipidemia take place in the endothelium. Novel approaches involving endothelial biomarkers and bioinformatics advances could open new perspectives in patient management.
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Affiliation(s)
- Edyta Dąbrowska
- Center of Translational Medicine, Medical University of Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland
| | - Krzysztof Narkiewicz
- Center of Translational Medicine, Medical University of Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Smoluchowskiego 17, 80-214, Gdańsk, Poland
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3
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Piccirillo G, Moscucci F, Mezzadri M, Caltabiano C, Di Diego I, Carnovale M, Corrao A, Stefano S, Scinicariello C, Giuffrè M, De Santis V, Sciomer S, Rossi P, Magrì D. Electrocardiographic and other Noninvasive Hemodynamic Markers in Decompensated CHF Patients. J Cardiovasc Dev Dis 2023; 10:125. [PMID: 36975889 PMCID: PMC10058439 DOI: 10.3390/jcdd10030125] [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: 01/04/2023] [Revised: 02/14/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Acutely decompensated chronic heart failure (adCHF) is among the most important causes of in-hospital mortality. R-wave peak time (RpT) or delayed intrinsicoid deflection was proposed as a risk marker of sudden cardiac death and heart failure decompensation. Authors want to verify if QR interval or RpT, obtained from 12-lead standard ECG and during 5-min ECG recordings (II lead), could be useful to identify adCHF. At hospital admission, patients underwent 5-min ECG recordings, obtaining mean and standard deviation (SD) of the following ECG intervals: QR, QRS, QT, JT, and T peak-T end (Te). The RpT from a standard ECG was calculated. Patients were grouped by the age-stratified Januzzi NT-proBNP cut-off. A total of 140 patients with suspected adCHF were enrolled: 87 (mean age 83 ± 10, M/F 38/49) with and 53 (mean age: 83 ± 9, M/F: 23/30) without adCHF. V5-, V6- (p < 0.05) RpT, and QRSD, QRSSD, QTSD, JTSD, and TeSDp < 0.001 were significantly higher in the adCHF group. Multivariable logistic regression analysis demonstrated that the mean of QT (p < 0.05) and Te (p < 0.05) were the most reliable markers of in-hospital mortality. V6 RpT was directly related to NT-proBNP (r: 0.26, p < 0.001) and inversely related to a left ventricular ejection fraction (r: 0.38, p < 0.001). The intrinsicoid deflection time (obtained from V5-6 and QRSD) could be used as a possible marker of adCHF.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Martina Mezzadri
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Cristina Caltabiano
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Ilaria Di Diego
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Myriam Carnovale
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Andrea Corrao
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Sara Stefano
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Claudia Scinicariello
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Marco Giuffrè
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Valerio De Santis
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Pietro Rossi
- Cardiology Division, Arrhytmology Unit, S. Giovanni Calibita Hospital, 00186 Rome, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, 00185 Rome, Italy
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Sevoz-Couche C, Laborde S. Heart rate variability and slow-paced breathing:when coherence meets resonance. Neurosci Biobehav Rev 2022; 135:104576. [DOI: 10.1016/j.neubiorev.2022.104576] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 01/08/2023]
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Air Pollution Role as Risk Factor of Cardioinhibitory Carotid Hypersensitivity. ATMOSPHERE 2022. [DOI: 10.3390/atmos13010123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Little is known about the impact of air pollution on neuroautonomic system. The authors have investigated possible influence of air pollution and outdoor temperature on the carotid sinus hypersensitivity (CSH), as main cause of neurally mediated syncope in forty-years-old subjects and older. Pollutants’ concentrations and outdoor temperature of days in which 179 subjects with recurrent syncope underwent carotid sinus massage (CSM) were analyzed. Before this manoeuvre, cardiovascular control by short period heart and blood pressure spectral duration of segment between the end of P and R ECG-waves (PeR) were registred; RR variability on the same short period ECG recordings and their spectral coherence were also analyzed. CSH was found in 57 patients (28 with cardioinhibitory response and 29 subjects showed vasodepressor reaction), while 122 subjects had a normal response. CSM performed during high ozone concentrations was associated with slightly higher risk of cardioinhibitory response (odd ratio 1.012, 95% CI 1.001–1.023, p < 0.05), but neither this or other polluting agent nor outdoor temperature seemed to influence autonomic control in basal resting condition. Thus, ozone seemed to influence response to the CSM in CSH patients and it is probably able to facilitate a cardioinhibitory response, perhaps through an increase of nerve acetylcholine release. P→PR coherence could be useful in predicting a sinus cardioinhibitory hypersensitivity in those cases when CSM is contraindicated.
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Kobalava ZD, Kokhan EV. Hypertension and Hypercholesterolemia: is it Time for Anti-«Lipitensive» Therapy? RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-09-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Despite the widespread awareness that hypertension and dyslipidemia are risk factors of prime importance for cardiovascular disease, the prevalence of these risk factors is still high, and the success of their control can hardly be considered satisfactory. The latest European guidelines for the management of hypertension strengthened the position of fixed-dose combinations, the main advantage of which is increased adherence to treatment. The purpose of this review was to discuss the background and the possibility of using fixed-dose combinations containing antihypertensive drugs and a statin in the treatment of patients with hypertension and dyslipidemia. We outlined the theoretical concepts that substantiate the possibility of using such therapy and discussed the results of randomized clinical trials investigating the efficacy of combined administration of antihypertensive and lipidlowering drugs. Illustrated by single pill combination of indapamide, perindopril and rosuvastatin, the requirements for fixed drug combinations are discussed, as well as clinical scenarios when their use is considered justified.
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Affiliation(s)
- Z. D. Kobalava
- Peoples' Friendship University of Russia (RUDN University)
| | - E. V. Kokhan
- Peoples' Friendship University of Russia (RUDN University)
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Rots ML, Fassaert LM, Kappelle LJ, de Groot MC, Haitjema S, Bonati LH, van Klei WA, de Borst GJ. Intra-Operative Hypotension is a Risk Factor for Post-operative Silent Brain Ischaemia in Patients With Pre-operative Hypertension Undergoing Carotid Endarterectomy. Eur J Vasc Endovasc Surg 2020; 59:526-534. [DOI: 10.1016/j.ejvs.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/28/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
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Piccirillo G, Moscucci F, Fabietti M, Parrotta I, Mastropietri F, Di Iorio C, Sabatino T, Crapanzano D, Vespignani G, Mariani MV, Salvi N, Magrì D. Arrhythmic Risk in Elderly Patients Candidates to Transcatheter Aortic Valve Replacement: Predictive Role of Repolarization Temporal Dispersion. Front Physiol 2019; 10:991. [PMID: 31447689 PMCID: PMC6691061 DOI: 10.3389/fphys.2019.00991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/18/2019] [Indexed: 12/30/2022] Open
Abstract
Background/Aim Degenerative aortic valve stenosis (AS) is associated to ventricular arrhythmias and sudden cardiac death, as well as mental stress in specific patients. In such a context, substrate, autonomic imbalance as well as repolarization dispersion abnormalities play an undoubted role. Aim of the study was to evaluate the increase of premature ventricular contractions (PVC) and complex ventricular arrhythmias during mental stress in elderly patients candidate to the transcatheter aortic valve replacement (TAVR). Methods In eighty-one elderly patients with AS we calculated several short-period RR- and QT-derived variables at rest, during controlled breathing and during mild mental stress, the latter being represented by a mini-mental state evaluation (MMSE). Results All the myocardial repolarization dispersion markers worsened during mental stress (p < 0.05). Furthermore, during MMSE, low frequency component of the RR variability increased significantly both as absolute power (LFRR) and normalized units (LFRRN U) (p < 0.05) as well as the low-high frequency ratio (LFRR/HFRR) (p < 0.05). Eventually, twenty-four (30%) and twelve (15%) patients increased significantly PVC and, respectively, complex ventricular arrhythmias during the MMSE administration. At multivariate logistic regression analysis, the standard deviation of QTend (QTesd), obtained at rest, was predictive of increased PVC (odd ratio: 1.54, 95% CI 1.14-2.08; p = 0.005) and complex ventricular arrhythmias (odd ratio: 2.31, 95% CI 1.40-3.83; p = 0.001) during MMSE. The QTesd showed the widest sensitive-specificity area under the curve for the increase of PVC (AUC: 0.699, 95% CI: 0.576-0.822, p < 0.05) and complex ventricular arrhythmias (AUC: 0.801, 95% CI: 0.648-0.954, p < 0.05). Conclusion In elderly with AS ventricular arrhythmias worsened during a simple cognitive assessment, this events being a possible further burden on the outcome of TAVR. QTesd might be useful to identify those patients with the highest risk of ventricular arrhythmias. Whether the TAVR could led to a QTesd reduction and, hence, to a reduction of the arrhythmic burden in this setting of patients is worthy to be investigated.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Federica Moscucci
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Marcella Fabietti
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Ilaria Parrotta
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Fabiola Mastropietri
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Claudia Di Iorio
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Teresa Sabatino
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Davide Crapanzano
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Giulia Vespignani
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Marco Valerio Mariani
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Nicolò Salvi
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Alnoor MS, Varner HK, Butler IJ, Zhu L, Numan MT. Baroreceptor activity and sensitivity: normal values in children and young adults using the head up tilt test. Pediatr Res 2019; 85:841-847. [PMID: 30728445 DOI: 10.1038/s41390-019-0327-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/16/2019] [Accepted: 01/28/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Baroreceptor function in children and adolescents has not been well studied in the current literature, with a lack of agreed upon normal values. The authors hypothesize that there is a significant increase in the baroreceptor activity with a decrease in the sensitivity during the upright phase in comparison to the supine phases of the head upright tilt test (HUTT) protocol. METHODS Baroreceptor evaluation was performed using the sequence method in 49 subjects ages 8-21 years, during the 3 phases of HUTT: supine, head up, and post-tilt supine positions. Baroreceptor Effectiveness Index (BEI) and the number and slope of baroreceptor events were recorded. RESULTS On study of the events and slope values, there was a significant difference between the three phases of the HUTT with regard to the baroreceptor activity and sensitivity. No significant difference was found in BEI. CONCLUSIONS Our study presents normal values of baroreceptor activity, sensitivity, and BEI in pediatric patients under controlled supine and head up position. We also present new data regarding delayed heart rate responses to pressure changes in the Lag 1 and Lag 2 parameters, which may be beneficial in diagnosis and management of pediatric patients with orthostatic intolerance.
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Affiliation(s)
- Mohammad S Alnoor
- Department of Pediatrics, McGovern Medical School The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Holly K Varner
- Department of Neurology, McGovern Medical School The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ian J Butler
- Division of Child and Adolescent Neurology, Department of Pediatrics, McGovern Medical School The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Liang Zhu
- Division of Clinical and Translational Research, Department of Internal Medicine, McGovern Medical School The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mohammed T Numan
- Division of Pediatric Cardiology, Department of Pediatrics, McGovern Medical School The University of Texas Health Science Center at Houston, Houston, TX, USA
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Wu J, Wang Y, Wang A, Jia J, Wang X, Zhao X. Association between non‐high‐density lipoprotein cholesterol levels and the prevalence of asymptomatic extracranial internal carotid artery stenosis in a Chinese community‐based study. Eur J Neurol 2019; 26:740-746. [DOI: 10.1111/ene.13882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/06/2018] [Indexed: 11/30/2022]
Affiliation(s)
- J. Wu
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases BeijingChina
- Center of Stroke Beijing Institute for Brain Disorders BeijingChina
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingChina
| | - Y. Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases BeijingChina
- Center of Stroke Beijing Institute for Brain Disorders BeijingChina
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingChina
| | - A. Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- Department of Epidemiology and Health Statistics School of Public Health Capital Medical University BeijingChina
- Beijing Municipal Key Laboratory of Clinical Epidemiology Beijing China
| | - J. Jia
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases BeijingChina
- Center of Stroke Beijing Institute for Brain Disorders BeijingChina
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingChina
| | - X. Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases BeijingChina
- Center of Stroke Beijing Institute for Brain Disorders BeijingChina
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingChina
| | - X. Zhao
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases BeijingChina
- Center of Stroke Beijing Institute for Brain Disorders BeijingChina
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingChina
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Zhao X, Xu H, Zou J, Qian Y, Yi H, Guan J, Yin S. Joint interaction effect of metabolic syndrome and obstructive sleep apnea on hypertension. J Clin Hypertens (Greenwich) 2018; 20:1203-1212. [PMID: 29893026 PMCID: PMC8031209 DOI: 10.1111/jch.13322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/17/2018] [Accepted: 04/28/2018] [Indexed: 11/28/2022]
Abstract
Numerous studies have observed a relationship between obstructive sleep apnea and hypertension, but the effects of metabolic syndrome on hypertension, and their interaction with obstructive sleep apnea, remain unclear. For this study, a total of 2972 patients were recruited from the Shanghai Sleep Health Study. Data from overnight polysomnography parameters, serum lipids, fasting blood glucose, blood pressure, and anthropometric measurements were collected. The authors then explored the independent associations and multiplicative and additive interactions of predictors of metabolic syndrome with hypertension. A positive dose-response relationship was observed between systolic blood pressure and diastolic blood pressure and quartiles of fasting glucose, triglyceride, low-density lipoprotein cholesterol, body mass index, and apnea-hypopnea index. Furthermore, logistic regression analysis showed that, in men, a high triglyceride level, hyperglycemia, and overweight status (and their interaction effect on obstructive sleep apnea) were associated with hypertension. Being overweight and hyperglycemic may markedly augment the adverse effect of obstructive sleep apnea on hypertension in men. Therefore, hypertension therapy should be individualized based on the specific comorbidities of each patient.
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Affiliation(s)
- Xiaolong Zhao
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep MedicineShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Clinical Research CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Huajun Xu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep MedicineShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Clinical Research CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jianyin Zou
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep MedicineShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Clinical Research CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yingjun Qian
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep MedicineShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Clinical Research CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hongliang Yi
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep MedicineShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
| | - Jian Guan
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep MedicineShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
| | - Shankai Yin
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep MedicineShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
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12
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DiFrancesco MW, Shamsuzzaman A, McConnell KB, Ishman SL, Zhang N, Huang G, Hossain M, Amin RS. Age-related changes in baroreflex sensitivity and cardiac autonomic tone in children mirrored by regional brain gray matter volume trajectories. Pediatr Res 2018; 83:498-505. [PMID: 29261644 PMCID: PMC5866169 DOI: 10.1038/pr.2017.273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 10/06/2017] [Indexed: 11/17/2022]
Abstract
BackgroundThe baroreflex and central autonomic brain regions together control the cardiovascular system. Baroreflex sensitivity (BRS) decreases with age in adults. Age-related changes in brain regions for cardiovascular control in children are unknown. We studied age-related changes in BRS, cardiac autonomic tone, and gray matter volume (GMV) of brain regions associated with cardiovascular control.MethodsBeat-to-beat blood pressure and heart rate (HR) were recorded in 49 children (6-14 years old). Spontaneous BRS was calculated by the sequence method. Cardiac autonomic tone was measured by spectral analysis of HR variability. GMV was measured using voxel-based morphometryin 112 healthy children (5-18 years old).ResultsAge-related changes in BRS were significantly different in children <10 years and ≥10 years. Age-related changes in GMV in regions of interest (ROI) were also significantly different between children <10 and ≥10 years and between children <11 and ≥11 years. However, age-related changes in cardiac autonomic tone were progressive.ConclusionsSignificant changes in BRS trajectories between <10 and ≥10 years may be associated with similar age-related changes of GMV in brain ROI. This new knowledge will guide future studies examining whether childhood cardiovascular disruption manifests as deviated maturation trajectories of specific brain regions.
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Affiliation(s)
- Mark W. DiFrancesco
- Pediatric Neuroimaging Research Consortium, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Abu Shamsuzzaman
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Keith B. McConnell
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Stacey L. Ishman
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Nanhua Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Guixia Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Monir Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Raouf S. Amin
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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Piccirillo G, Ottaviani C, Fiorucci C, Petrocchi N, Moscucci F, Di Iorio C, Mastropietri F, Parrotta I, Pascucci M, Magrì D. Transcranial direct current stimulation improves the QT variability index and autonomic cardiac control in healthy subjects older than 60 years. Clin Interv Aging 2016; 11:1687-1695. [PMID: 27895475 PMCID: PMC5117948 DOI: 10.2147/cia.s116194] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Noninvasive brain stimulation technique is an interesting tool to investigate the causal relation between cortical functioning and autonomic nervous system (ANS) responses. Objective The objective of this report is to evaluate whether anodal transcranial direct current stimulation (tDCS) over the temporal cortex influences short-period temporal ventricular repolarization dispersion and cardiovascular ANS control in elderly subjects. Subjects and methods In 50 healthy subjects (29 subjects younger than 60 years and 21 subjects older than 60 years) matched for gender, short-period RR and systolic blood pressure spectral variability, QT variability index (QTVI), and noninvasive hemodynamic data were obtained during anodal tDCS or sham stimulation. Results In the older group, the QTVI, low-frequency (LF) power expressed in normalized units, the ratio between LF and high-frequency (HF) power, and systemic peripheral resistances decreased, whereas HF power expressed in normalized units and α HF power increased during the active compared to the sham condition (P<0.05). Conclusion In healthy subjects older than 60 years, tDCS elicits cardiovascular and autonomic changes. Particularly, it improves temporal ventricular repolarization dispersion, reduces sinus sympathetic activity and systemic peripheral resistance, and increases vagal sinus activity and baroreflex sensitivity.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | | | - Claudia Fiorucci
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | | | - Federica Moscucci
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | - Claudia Di Iorio
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | - Fabiola Mastropietri
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | - Ilaria Parrotta
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | - Matteo Pascucci
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, University of Rome "Sapienza", Rome, Italy
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Otsuka T, Takada H, Nishiyama Y, Kodani E, Saiki Y, Kato K, Kawada T. Dyslipidemia and the Risk of Developing Hypertension in a Working-Age Male Population. J Am Heart Assoc 2016; 5:e003053. [PMID: 27016576 PMCID: PMC4943276 DOI: 10.1161/jaha.115.003053] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertension is one of the main comorbidities associated with dyslipidemia. This study aimed to examine the extent to which dyslipidemia increases the risk of developing hypertension in a Japanese working-age male population. METHODS AND RESULTS We analyzed data from 14 215 nonhypertensive male workers (age 38±9 years) who underwent annual medical checkups. Subjects were followed up for a median of 4 years to determine new-onset hypertension, defined as blood pressure (BP) ≥140/90 mm Hg or use of antihypertensive medication. The associations between serum lipid levels and development of hypertension were examined. During the follow-up period, 1483 subjects developed hypertension. After adjusting for age, body mass index, impaired fasting glucose/diabetes, baseline BP category, alcohol intake, smoking, exercise, and parental history of hypertension, subjects with a total cholesterol (TC) level ≥222 mg/dL were at a significantly increased risk of developing hypertension (hazard ratio: 1.28; 95% CI: 1.06-1.56) compared to subjects with a TC level ≤167 mg/dL. Similar results were observed for subjects with high low-density lipoprotein cholesterol (LDLC) and non-high-density lipoprotein cholesterol (HDLC) levels. A U-shaped relationship was found between HDLC level and risk of hypertension; compared to the third quintile, the multiadjusted hazard ratio was 1.22 (95% CI: 1.03-1.43) in the lowest quintile and 1.34 (95% CI: 1.12-1.60) in the highest quintile. CONCLUSIONS Elevated serum levels of TC, LDLC, and non-HDLC were associated with an increased risk of hypertension in working-age Japanese men. For HDLC, risk of hypertension was increased at both low and high levels.
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Affiliation(s)
- Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | - Hirotaka Takada
- Industrial Safety and Health Center, Canon Inc., Tokyo, Japan
| | - Yasuhiro Nishiyama
- Department of Neurology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Yoshiyuki Saiki
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | - Katsuhito Kato
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | - Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
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15
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Piccirillo G, Moscucci F, Pascucci M, Pappadà MA, D'Alessandro G, Rossi P, Quaglione R, Di Barba D, Barillà F, Magrì D. Influence of aging and chronic heart failure on temporal dispersion of myocardial repolarization. Clin Interv Aging 2013; 8:293-300. [PMID: 23662051 PMCID: PMC3646393 DOI: 10.2147/cia.s41879] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Indexed: 01/01/2023] Open
Abstract
Background and purpose: QT and Tpeak-Tend (Te) intervals are associated with sudden cardiac death
in patients with chronic heart failure (CHF). We studied age-dependent influence on short-term
temporal dispersion of these two variables in patients with postischemic CHF. Method: We grouped 75 CHF and 53 healthy control subjects into three age subsets: ≤50 years,
>50 years and ≤65 years, and >65 years. We then calculated the following
indices: QT and Te variability index (QTVI and TeVI), the ratio between the short-term variability
(STV) of QT or Te, and the STV of resting rate (RR) (QT/RR STV and Te/RR STV). Results: In all different age subgroups, patients with CHF showed a higher level of QTVI than age-matched
control subjects (≤50 years: P < 0.0001; >50 years and
≤65 years: P < 0.05; >65 years: P
< 0.05). Patients with CHF < 50 years old also had all repolarization variability
indices higher than normal age-matched controls (TeVI, P < 0.05; QT/RR STV,
P < 0.05; Te/RR STV, P < 0.05), whereas we did not
find any difference between the two older classes of subjects. Both QTVI
(r2: 0.178, P < 0.05) and TeVI
(r2: 0.433, P < 0.001) were positively related
to age in normal subjects, even if the first correlation was weaker than the second one. Conclusion: Our data showed that QTVI could be used in all ages to evaluate repolarization temporal
liability, whereas the other indices are deeply influenced by age. Probably, the age-dependent
increase in QTVI was more influenced by a reduction of RR variability reported in older normal
subjects.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Cardiovascular, Respiratory, Nephrological and Geriatric Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
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16
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Piccirillo G, Rossi P, Mitra M, Quaglione R, Dell'Armi A, Di Barba D, Maisto D, Lizio A, Barillà F, Magrì D. Indexes of temporal myocardial repolarization dispersion and sudden cardiac death in heart failure: any difference? Ann Noninvasive Electrocardiol 2012; 18:130-9. [PMID: 23530483 DOI: 10.1111/anec.12005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The QT variability index, calculated between Q- and the T-wave end (QTend VI), is an index of temporal myocardial repolarization lability associated with sudden cardiac death (SCD) in chronic heart failure (CHF). Little is known about temporal variability in the other two temporal myocardial repolarization descriptors obtained from Q-Tpeak and Tpeak -Tend intervals. We therefore investigated differences between these indexes in patients with CHF who died suddenly and in those who survived with a left ventricular ejection fraction (LVEF) ≤35% or >35%. METHODS AND RESULTS We selected 127 ECG and systolic blood pressure (SPB) recordings from outpatients with CHF all of whom had been followed up for 30 months. We calculated RR and SPB variability by power spectral analysis and QTend VI, QTpeak VI, Tpeak Tend VI. We then subdivided data patients into three groups SCD, LVEF ≤ 35%, and LVEF > 35%. The LVEF was higher in the SCD than in the LVEF ≤ 35% group, whereas no difference was found between the SCD and LVEF > 35% groups. QTend VI, QTpeak VI, and Tpeak Tend VI were higher in the SCD and LVEF ≤ 35% groups than in the LVEF > 35% group. Multivariate analysis detected a negative relationship between all repolarization variability indexes, low frequency obtained from RR intervals and LVEF. CONCLUSIONS Our data show that variability in the first (QTpeak VI) and second halves of the QT interval (Tpeak -Tend VI) significantly contributes to the QTend VI in patients with CHF. Further studies should investigate whether these indexes might help stratify the risk of SCD in patients with a moderately depressed LVEF.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Cardiovascular, Respiratory, Nephrologic, and Geriatric Sciences, Sapienza University of Rome, 00185 Rome, Italy.
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Demirel S, Attigah N, Bruijnen H, Macek L, Hakimi M, Able T, Böckler D. Changes in baroreceptor sensitivity after eversion carotid endarterectomy. J Vasc Surg 2012; 55:1322-8. [DOI: 10.1016/j.jvs.2011.11.134] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 11/21/2011] [Accepted: 11/28/2011] [Indexed: 11/30/2022]
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Mokhtar RH, Ayob A, Noor NM. Blood Pressure Variability in Patients with Diabetes Mellitus. Asian Cardiovasc Thorac Ann 2010; 18:344-8. [DOI: 10.1177/0218492310375723] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Reduced arterial compliance in patients with diabetes mellitus has been shown in several studies, but it has not been significantly associated with either atherosclerosis or vessel wall thickness. Blood pressure variability is still poorly explored in diabetic patients. The aim of this study was to compare blood pressure variability and arterial compliance in patients with type 2 diabetes mellitus and controls matched for sex, age, and weight. Arterial compliance was measured and noninvasive 24-h ambulatory blood pressure monitoring was performed in 18 diabetic patients and 18 controls. There was significantly higher 24-h systolic blood pressure variability (17.7 ± 6.8 vs. 14.6 ± 2.6 mm Hg), diastolic blood pressure variability (15.6 ± 7.1 vs. 11.4 ± 3.1 mm Hg), and mean arterial blood pressure variability (14.8 ± 7.0 vs. 11.1 ± 2.9) in diabetic patients. Systolic, diastolic, and mean arterial blood pressure variability was significantly higher during daytime but not night time in diabetic patients compared to controls. Diabetic patients also had significantly reduced small artery compliance, but no differences in large artery compliance, cardiac output, or systemic vascular resistance. The findings suggest that hyperglycemia may affect the compliance of the vascular system, resulting in high blood pressure fluctuations.
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Affiliation(s)
| | | | - Noriah Mohd Noor
- Faculty of Pharmacy International Islamic University of Malaysia Bandar Indera Mahkota, Pahang, Malaysia
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19
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Mourey F, Brondel L, Van Wymelbeke V, Buchheit M, Moreau D, Pfitzenmeyer P. Assessment of cardiac autonomic nervous activity in frail elderly people with postural abnormalities and in control subjects. Arch Gerontol Geriatr 2009; 48:121-4. [DOI: 10.1016/j.archger.2007.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 11/01/2007] [Accepted: 11/08/2007] [Indexed: 10/22/2022]
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20
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Piccirillo G, Magrì D, di Carlo S, De Laurentis T, Torrini A, Matera S, Magnanti M, Bernardi L, Barillà F, Quaglione R, Ettorre E, Marigliano V. Influence of cardiac-resynchronization therapy on heart rate and blood pressure variability: 1-year follow-up. Eur J Heart Fail 2006; 8:716-22. [PMID: 16513420 DOI: 10.1016/j.ejheart.2006.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 11/14/2005] [Accepted: 01/18/2006] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Several studies have shown that cardiac-resynchronization therapy (CRT) improves haemodynamic function, cardiac symptoms, and heart rate variability (HRV) and reduces the risk of mortality and sudden death in subjects with chronic heart failure (CHF). In subjects with CHF, power spectral values for the low-frequency (LF) component of RR variability < or =13 ms2, are associated with an increased risk of sudden death. AIMS AND METHODS To assess whether spectral indexes obtained by power spectral analysis of HRV and systolic blood pressure (SBP) variability could predict malignant ventricular arrhythmias in patients with severe CHF treated with an implantable cardioverter-defibrillator (ICD) alone or with ICD+CRT. In addition, changes in non-invasive spectral indices using short-term power spectral analysis of HRV and SBP variability during controlled breathing in 15 patients with CHF treated with an ICD alone and 16 patients receiving ICD+CRT, were assessed pre-treatment and at 1 year. RESULTS Arrhythmias necessitating an appropriate ICD shock were more frequent in subjects who had low LF power. CRT improved all spectral components, including LF power. CONCLUSIONS Low LF power values predict an increased risk of malignant ventricular arrhythmias; after 1 year of CRT most non-spectral and spectral data, including LF power, improved. Whether these improvements lead to better long-term survival in patients with CHF remains unclear.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze dell'Invecchiamento, I Clinica Medica, Policlinico Umberto I, Università La Sapienza, 00161 Rome, Italy.
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21
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Doux JD, Yun AJ. The link between carotid artery disease and ischemic stroke may be partially attributable to autonomic dysfunction and failure of cerebrovascular autoregulation triggered by Darwinian maladaptation of the carotid baroreceptors and chemoreceptors. Med Hypotheses 2006; 66:176-81. [PMID: 16274832 DOI: 10.1016/j.mehy.2005.03.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2005] [Accepted: 03/20/2005] [Indexed: 11/19/2022]
Abstract
Carotid artery stenosis is generally thought to induce stroke by either compromising cerebral perfusion or inciting embolic phenomena. Carotid baroreceptors and chemoreceptors are vital adaptations for cerebrovascular autoregulation that can behave mal-adaptively in the setting of modern diseases such as atherosclerosis. We hypothesize that acute cerebrovascular events may be partially attributable to autonomic dysfunction and cerebrovascular autoregulatory failure secondary to carotid sensor maladaptations. Specifically, we propose that atherosclerotic disease at the carotid bifurcation can interfere with baroreceptor and chemoreceptor function by buffering against accurate detection of physical and chemical parameters. Misperceptions of hypoxia and hypotension can trigger sympathetic bias and autonomic dysfunction which perturb cerebrovascular autoregulation and vasomotor tone, thereby compromising cerebral perfusion. The preferential association of strokes with morning arousal, stress, acute physical activity, winter months, illness, and older age may relate to this phenomenon. Sympathetic bias promotes inflammation and coagulation, a link likely forged during prehistoric evolution when trauma represented a more significant factor in natural selection. In the setting of carotid sensor dysfunction, the resulting inflammation and coagulation can promote acute cardiovascular events. The ensuing cerebral ischemia can induce further derangement of cerebrovascular autoregulation and upregulate adrenergia, inflammation, and coagulation in a feed-forward manner. Inflammation and coagulation can also exacerbate carotid sensor dysfunction by iteratively worsening atherosclerosis. Angioplasty, stenting, and endarterectomy may inadvertently cause acute and chronic carotid sensor dysfunction through manipulation, material interposition, and balloon-induced baroreceptor injury. Acute strokes during these procedures may result from carotid sensor dysfunction rather than embolization. Carotid body and sinus electro-modulation and non-balloon atherectomy represent new methods to prevent or treat cerebrovascular events. Pharmacologic modulation of autonomic balance, such as adrenergic blockade, long presumed contraindicated due to risk of cerebral hypoperfusion, may counter-intuitively offer benefit during acute strokes. Novel diagnostic paradigms may include functional analysis of carotid sensors as well as measurement of the anatomic thickness of calcified and non-calcified plaque near the carotid body. Carotid sensor dysfunction may be a source of systemic sympathetic bias and autonomic dysfunction observed during aging and, by association, many of the ailments associated with senescence. Modulation of carotid sensors may yield pervasive health benefits beyond those found by treating cerebrovascular disease.
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Affiliation(s)
- John D Doux
- Department of Dermatology, Stanford University Medical Center, Palo Alto, CA 94301, USA
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22
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Piccirillo G, Magrì D, Di Carlo S, Matera S, Magnanti M, De Laurentis T, Torrini A, Marchitto N, Lionetti M, Moisè A. Power spectral analysis of heart rate variability as a predictive test in choosing the most effective length for tilt-training. Int J Cardiol 2006; 111:59-66. [PMID: 16081172 DOI: 10.1016/j.ijcard.2005.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Revised: 06/25/2005] [Accepted: 07/04/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND In patients with refractory neurally mediated syncope, tilt training--standing motionless against a wall for increased periods of time per day over one month--can often eliminate recurrent episodes and reduce presyncopal symptoms. We designed dual retrospective and prospective studies to assess cardiovascular autonomic function in subjects with recurrent syncope and identify the most effective length of tilt training between one and three months. METHODS AND RESULTS In the retrospective study, before tilt training, and in the prospective study, before and after training, all subjects underwent a recording for short-term spectral analysis of heart rate and systolic blood pressure variability. Before tilt-training, autonomic nervous system function differs in patients with recurrent neurally mediated syncope who respond to tilt training for one month and those who do not. "Responders", patients experiencing no episodes of syncope during the 12-month follow-up, had higher low-frequency power of RR (LF(RR)) (p < 0.05) and LF(RR) in normalized units (NU) (p < 0.001) and lower high-frequency power (HF(RR)) (p < 0.05) and HF(RR)NU (p < 0.001) than "non-responders", patients reporting at least one syncopal episode during the 12-month follow-up. In the retrospective study, no difference was found between spectral data for "non-responders" with positive responses to tilt test with and without nitro derivatives. Prolonging tilt-training to three months increased the number of responders (late-responders) by 80% (p < 0.001) and power spectral analysis of heart rate variability (HRV) before tilt training can identify late-responders by their low LF(RR)NUs (<40) and high HF(RR)Nus (>60). Furthermore in late-responders, tilt training brings about a change in cardiovascular autonomic function: at 3 months, LF(RR)NUs increase and HF(RR)NU diminish. CONCLUSION Power spectral analysis of HRV seems to be a useful tool to preselect patients who are most likely to benefit from prolonged therapy, thus increasing compliance.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze dell'Invecchiamento, I Clinica Medica, Policlinico Umberto I, 00161 Rome, Italy.
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23
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Piccirillo G, Germanò G, Vitarelli A, Ragazzo M, di Carlo S, De Laurentis T, Torrini A, Matera S, Magnanti M, Marchitto N, Bonanni L, Magrì D. Autonomic cardiovascular control and diastolic dysfunction in hypertensive subjects. Int J Cardiol 2006; 110:160-6. [PMID: 16051387 DOI: 10.1016/j.ijcard.2005.06.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Revised: 06/17/2005] [Accepted: 06/18/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early hypertension is associated with left ventricular diastolic dysfunction due to increased end-diastolic pressure. This increase, through the cardiopulmonary reflexes, can influence autonomic cardiovascular control. METHODS We assessed autonomic nervous system modulation of cardiovascular signals by power spectral analysis of RR interval and systolic arterial pressure variabilities in subjects with recently diagnosed hypertension with or without diastolic dysfunction and in normotensive control subjects. RESULTS Both hypertensive groups had higher low-frequency (LF) power expressed in normalized units (NUs) than normotensive controls (p < 0.05; p < 0.001) during controlled breathing at rest. The LF spectral index measured after tilt was greater in hypertensive subjects with diastolic dysfunction than in those without (p < 0.05). LF NUs measured at rest correlated significantly with the E/A wave ratio and after tilt with the E-wave deceleration time. CONCLUSIONS These results seem to indicate that in subjects with recently diagnosed hypertension sympathetic modulation of the sinus node prevails. During tilt, a maneuver designed to stimulate systemic arterial and cardiopulmonary baroreceptor reflexes, hypertensive subjects with diastolic dysfunction, who presumably also have higher end-diastolic pressures, seem to have greater sympathetic modulation of the sinus node than hypertensive subjects without diastolic dysfunction.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze dell'Invecchiamento, Policlinico Umberto I, Università La Sapienza, Rome, Italy.
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Parati G, Lantelme P. Mechanical and neural components of the cardiac baroreflex: new insights into complex physiology. J Hypertens 2005; 23:717-20. [PMID: 15775773 DOI: 10.1097/01.hjh.0000163137.59341.c3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Piccirillo G, Magrì D, Naso C, di Carlo S, MoisE A, De Laurentis T, Torrini A, Matera S, Nocco M. Factors influencing heart rate variability power spectral analysis during controlled breathing in patients with chronic heart failure or hypertension and in healthy normotensive subjects. Clin Sci (Lond) 2004; 107:183-90. [PMID: 15046616 DOI: 10.1042/cs20030401] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2003] [Revised: 03/12/2004] [Accepted: 03/26/2004] [Indexed: 11/17/2022]
Abstract
A decreased LFP (low-frequency power) spectral component of HRV [HR (heart rate) variability] is a risk factor for sudden death in patients with CHF (chronic heart failure). In the present study, we evaluated factors (age, arterial pressures and HR) influencing LFP and HFP (high-frequency power) components in short-term recordings during controlled breathing in patients with CHF or hypertension, and healthy normotensive subjects. In patients with CHF, we also compared LFP values with known markers of sudden death [NYHA (New York Heart Association) class, HR and ejection fraction]. All HRV measures were significantly lower in patients with CHF than in hypertensive and normotensive subjects (P<0.001), and in hypertensive than in normotensive subjects (P<0.05). Stepwise multiple regression analysis showed that, in patients with CHF, LFP was inversely associated with NYHA class (β=−0.5, P<0.0001) and HR (β=−0.2, P=0.001) and was positively associated with ejection fraction (β=0.28, P<0.0001). In patients with CHF, LFP remained unchanged with age. In normotensive and hypertensive subjects, HFP decreased with age, but in patients with CHF it did not. In the ≥60<70 and ≥70 years of age subgroups, we found no difference between HFP in the three groups studied. Hence, in normotensives and hypertensives, LFP tended to diminish with age (β=−0.4, P<0.0001 in normotensives; β=−0.4, P<0.001 in hypertensives) and was inversely associated with HR (β=−0.2, P=0.002 in normotensives; β=−0.3, P=0.002 in hypertensives). Conversely, in patients with CHF, LFP is predominantly influenced by NYHA class, HR and ejection fraction, but not by age. LFP might therefore increase the sensitivity of factors already used in stratifying the risk of sudden death in patients with CHF.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze dell'Invecchiamento, Policlinico Umberto I, Università La Sapienza, Rome, Italy.
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26
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Piccirillo G, Naso C, Moisè A, Lionetti M, Nocco M, Di Carlo S, De Laurentis T, Magrì D, Cacciafesta M, Marigliano V. Heart rate and blood pressure variability in subjects with vasovagal syncope. Clin Sci (Lond) 2004; 107:55-61. [PMID: 14982493 DOI: 10.1042/cs20030327] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2003] [Revised: 01/29/2004] [Accepted: 02/25/2004] [Indexed: 11/17/2022]
Abstract
Autonomic nervous system control in subjects with vasovagal syncope is controversial. In the present study, we used short-term spectral analysis to evaluate autonomic control in subjects with recurrent vasovagal syncope. We assessed the ability of spectral indices of HR (heart rate) variability to predict tilt-test responses. A series of 47 outpatients with recurrent vasovagal syncope and with positive responses to head-up tilt testing underwent a further study of RR variability during controlled breathing at rest and during tilt testing. During controlled breathing, RR interval variability of total power (TPRR; P<0.001), low-frequency power (LFRR; P<0.05), high-frequency power (HFRR; P<0.001) and HF expressed in normalized units (HFnuRR; P<0.001) were all higher, and LF expressed in normalized units (LFnuRR) and LF/HF ratio were lower in subjects with vasovagal syncope than in controls (P<0.001). To assess the ability of spectral components of RR variability to predict tilt-test responses, we prospectively studied 109 subjects with recurrent vasovagal syncope. The two normalized measures, HFnuRR and LFnuRR, determined during controlled breathing alone predicted a positive tilt-test response (sensitivity, 76%; specificity, 99%; positive predictive value, 96%; and negative predictive value, 90%). During tilting, subjects with vasovagal syncope had lower SBP (systolic blood pressure; P<0.05), LF component of peak SBP variability (LFSBP) and LFnuRR than controls, and higher TPRR, HFRR, HFnuRR and α HF (P<0.001). These spectral data indicate that vagal sinus modulation is increased at rest in subjects with vasovagal syncope. Spectral analysis of RR variability during controlled breathing, a procedure that predicts tilt-test responses, could be a useful guide in choosing the method of tilt testing.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze dell'Invecchiamento, Policlinico Umberto I, Università La Sapienza, 00161 Rome, Italy.
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Piccirillo G, Raffaele Q, Fimognari F, Moisè A, Mario M, Lionetti M, Naso C, Di Carlo S, Nocco M, Magrì D. Influence of L-arginine and vitamin C on the autonomic nervous system in chronic heart failure secondary to ischemic cardiomyopathy. Am J Cardiol 2004; 93:650-4. [PMID: 14996603 DOI: 10.1016/j.amjcard.2003.11.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2003] [Revised: 11/03/2003] [Accepted: 11/03/2003] [Indexed: 10/26/2022]
Abstract
In this study, we used spectral analysis to assess changes in respiratory recording variability during infusion of L-arginine and vitamin C, individually or together, in patients with chronic heart failure. We found that healthy subjects have a substantial ability to modulate sympathetic-mediated peripheral vascular resistance through endothelial synthesis of nitric oxide. Patients with chronic heart failure lose this ability.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze dell'Invecchiamento, Policlinico Umberto I, Università La Sapienza, Rome, Italy.
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Piccirillo G, Nocco M, Moisè A, Lionetti M, Naso C, di Carlo S, Marigliano V. Influence of vitamin C on baroreflex sensitivity in chronic heart failure. Hypertension 2003; 41:1240-5. [PMID: 12743013 DOI: 10.1161/01.hyp.0000073581.74107.22] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic heart failure (CHF) reduces baroreflex sensitivity. Low baroreflex sensitivity, a risk factor for sudden death, could arise partly from CHF-dependent endothelial dysfunction. Vitamin C at high doses has a protective role against CHF-related endothelial damage. This study was conducted to investigate the effect of vitamin C on baroreflex sensitivity in CHF. A study group of 33 subjects with CHF secondary to postischemic dilated cardiomyopathy with an ejection fraction </=35% and a control group (11 subjects) underwent assessment of baroreflex sensitivity by the phenylephrine method and an autonomic nervous system study by power spectral analysis. Variables were assessed after infusion of placebo and high doses of vitamin C (2.5 mg). In subjects with CHF, baroreflex sensitivity was significantly higher after vitamin C than after placebo infusion (placebo: 4.1+/-0.4 versus vitamin C: 5.3+/-0.5 ms/mm Hg, P<0.001). Low-frequency of R-R (LFRR), expressed in normalized units (NU) (P<0.05); LF/high-frequency (HF) ratio (P<0.05), and LF of SBP (LFSBP) decreased significantly; HF power (P<0.05), and alpha-HF (P<0.001) increased. Conversely, in the control group, baroreflex sensitivity and other spectral variables measured at baseline, after placebo, and after vitamin C infusion remained statistically unchanged (placebo: 10.2+/-0.1 versus vitamin C: 10.0+/-0.2 ms/mm Hg, NS). Acute administration of vitamin C at high doses improves baroreflex sensitivity and vagal sinus modulation in patients with CHF. This finding could have notable clinical and therapeutic implications. Key issues to understand are whether the beneficial effect persists during chronic administration and whether it helps to improve survival.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze dell'Invecchiamento, I Clinica Medica, Policlinico Umberto I, Università La Sapienza, 00161 Rome, Italy.
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Piccirillo G, Quaglione R, Nocco M, Naso C, Moisè A, Lionetti M, Di Carlo S, Marigliano V. Effects of long-term beta-blocker (metoprolol or carvedilol) therapy on QT variability in subjects with chronic heart failure secondary to ischemic cardiomyopathy. Am J Cardiol 2002; 90:1113-7. [PMID: 12423713 DOI: 10.1016/s0002-9149(02)02778-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Chronic heart failure (CHF) is a risk factor for sudden death. Temporal and spatial changes in repolarization are among the most studied mechanisms for inducing fatal ventricular arrhythmias. Beta blockers effectively reduce the risk of sudden death in CHF. Our aim in this study was to investigate changes induced by metoprolol and carvedilol on the QT variability index (QTVI), a new measure reflecting the temporal heterogeneity of cardiac repolarization. A total of 82 subjects, who were in New York Heart Association functional class II or III, underwent short-term spectral analysis of RR and QT variability before and after a 1-year course of high-dose metoprolol (40 subjects) or carvedilol (42 subjects) at baseline (rest) and after sympathetic stress (head-up tilt). At rest, both drug-treated groups had lower QTVI (p <0.001) than after placebo, but during tilt patients treated with carvedilol had a lower QTVI than those treated with metoprolol (p <0.05). Although both beta-blocker treatments helped to normalize the QTVI measured in normal subjects at rest, they each differentially altered the index after tilt. Carvedilol seemed to improve the QTVI more than metoprolol.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze dell'Invecchiamento, Istituto del Cuore, Policlinico Umberto I, Universita La Sapienza, 00161 Rome, Italy.
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Ueno LM, Hamada T, Moritani T. Cardiac autonomic nervous activities and cardiorespiratory fitness in older men. J Gerontol A Biol Sci Med Sci 2002; 57:M605-10. [PMID: 12196499 DOI: 10.1093/gerona/57.9.m605] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Aging associated changes in sympatho-vagal activities have been widely studied. However, little is known about the association between cardiorespiratory fitness level and cardiac autonomic nervous activities in conjunction with baroreflex sensitivity in healthy older men. METHODS We performed an incremental submaximal exercise test in 24 healthy, older men aged 60-70 years. They were divided into physically fit (PF, oxygen uptake at anaerobic threshold [ATO(2)] = 25.2 +/- 0.85 ml.kg(-1).min(-1)) and physically unfit (PU, ATO(2) = 19.6 +/- 0.42 ml.kg(-1).min(-1)) groups, based upon the results of an incremental exercise stress test. The cardiac autonomic nervous system (ANS) activities were assessed by means of power spectral analysis of heart rate variability. Baroreflex sensitivity (BRS) testing was performed using simultaneous beat-by-beat blood pressure and heart rate measurement during a transition from supine horizontal position to 60 degrees head-up-tilting (HUT). RESULTS At rest conditions, the high-frequency component ( p =.03) and total power ( p =.04) of heart rate variability spectrum were significantly higher in the PF group. The BRS assessed during passive HUT was also significantly higher (7.5 +/- 0.5 vs 3.0 +/- 0.4 ms.mm Hg(-1), p =.001) in the PF compared with the PU group. In addition, a significant correlation coefficient (r =.73, p =.001) was found between ATO(2) and BRS among the subjects. CONCLUSIONS The maintenance of high cardiorespiratory function, i.e., higher ATO(2) through a life-long active lifestyle including endurance exercise, may play an important role in reserving cardiac ANS and BRS in older men.
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Affiliation(s)
- Linda Massako Ueno
- Laboratory of Applied Physiology, Graduate School of Human and Environmental Studies, Kyoto University, Japan
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Lantelme P, Khettab F, Custaud MA, Rial MO, Joanny C, Gharib C, Milon H. Spontaneous baroreflex sensitivity: toward an ideal index of cardiovascular risk in hypertension? J Hypertens 2002; 20:935-44. [PMID: 12011655 DOI: 10.1097/00004872-200205000-00029] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Estimating the risk entailed by classical risk factors like blood pressure (BP) or serum cholesterol may be difficult because of their variability and the often unknown duration of exposure. Having variables integrating the impact of those classical risk factors on the cardiovascular system would probably aid the prediction of cardiovascular events. The present study aimed at determining whether cardiac baroreflex sensitivity (BRS), correlates with several risk factors and thus is a good candidate for being such an integrative variable. As a comparison, left ventricular mass (LVM), pulse wave velocity (PWV), and creatinine were also tested for association with risk factors. DESIGN A total of 302 subjects referred for hypertension, were considered. They had a 24-h BP recording and a determination of BRS by two different methods (sequence and alpha coefficient), in two different positions (lying and standing). They were also tested for the presence of left ventricular hypertrophy (LVH) (by echocardiography and electrocardiogram) and had a PWV measurement. Biological testing included serum lipids, blood glucose, creatinine, proteinuria and urinary excretion of microalbumin. RESULTS There was a strong correlation between the two methods of BRS measurement in each position (P < 0.001). BRS determined by the sequence method in the lying position was correlated significantly and independently with age, 24-h systolic BP, heart rate, and serum cholesterol with P values < 0.001, < 0.001, < 0.01, and < 0.05, respectively. In an univariate analysis, BRS was also correlated with echocardiographic LVM index (r = -0.21, P < 0.05) and PWV (r = -0.27, P < 0.001), which possibly reflects its dependence on both vascular and cardiac damages. CONCLUSION The present study supports the hypothesis that BRS could encompass the impact over time of several risk factors on the cardiovascular system. Thus, it may constitute a valuable parameter in assessing more precisely the risk of cardiovascular events.
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Affiliation(s)
- Pierre Lantelme
- Service de Cardiologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon et Faculté de Médecine Lyon-Nord, Lyon, France.
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