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Li J, Sun W, Yang X, Tu B, Cai S, Hu F, Weng Z, Liu S, Lai Z, Zheng L, Yao Y. Characteristics of deceleration capacity and deceleration runs in vasovagal syncope. Clin Auton Res 2024; 34:143-151. [PMID: 37776375 DOI: 10.1007/s10286-023-00989-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE Increased vagal activity plays a prominent role in vasovagal syncope (VVS). The aim of this study was to characterize vagal function in VVS by evaluating the heart rate (HR) deceleration capacity (DC) and the HR deceleration runs (DRs) in patients with VVS between attacks. METHODS A total of 188 consecutive VVS patients were enrolled in the study, of whom 129 had positive head-up tilt test (HUTT); 132 healthy participants were enrolled as controls. DC, DRs (DR2, i.e., episodes of 2 consecutive beat-to-beat HR decelerations), and the sum of DR8-10 (very long DR [VLDR]) were calculated using 24-h electrograms. Clinical characteristics, DC, and DRs were compared among syncope groups and controls. RESULTS Patients with VVS had higher DC (10.63 ± 2.1 vs. 6.58 ± 1.7 ms; P < 0.001) and lower minimum HR and DR6-10 than controls. No significant differences in DC or DR6-10 were found between the patients with positive and those with negative HUTT results. In multivariate logistic regression analysis, minimum HR ≥ 40 bpm (odds ratio [OR] 0.408, 95% confidence interval [CI] 0.167-0.989; P = 0.048), daytime DC ≥ 7.37 ms (OR 3.040, 95% CI 1.220-7.576; P = 0.013), and VLDR ≥ 0.046% (OR 0.306, 95% CI 0.138-0.679; P = 0.004) were demonstrated to be risk factors significantly associated with VVS. CONCLUSION Compared to healthy controls, patients with VVS demonstrated distinct HR deceleration profiles between attacks, including overall higher DC and lower DR6-10.
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Affiliation(s)
- Jiakun Li
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Sun
- Cardiology department, Eastern Health-Box Hill Hospital, Melbourne, Australia
| | - Xu Yang
- Premium Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Tu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Simin Cai
- Cardiac Arrhythmia Center, Huazhong Fuwai Hospital, Heart Center, Henan Provincial People's Hospital, The People's Hospital of Zhengzhou University, Henan, China
| | - Feng Hu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhiyuan Weng
- Cardiovascular Department, Fujian Institute of Hypertension, The First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Shangyu Liu
- Department of Cardiovasology, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang, 050031, Hebei, China
| | - Zihao Lai
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lihui Zheng
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yan Yao
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Wang L, Ansari S, Cai Y, McCracken B, Tiba MH, Ward K, Najarian K, Oldham K. Tracking Peripheral Artery Motion and Vascular Resistance with a Multi-Modal Wearable Sensor Under Pressure Perturbations. J Biomech Eng 2022; 144:1133339. [PMID: 35079769 DOI: 10.1115/1.4053399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Indexed: 11/08/2022]
Abstract
Peripheral artery status is a key physiological indicator of the body's cardiovascular response to both acute and chronic medical conditions. In this paper, peripheral artery behavior is tracked non-invasively by combining a photo plethysmograph (PPG) sensor and a piezoelectric (polyvinylidene difluoride, PVDF) sensor, while applying an outside pressure-varying cuff. A simple mechanical model for the local artery and tissue captures time- and pressure-dependent features present in the PPG and PVDF signals with respect to applied cuff pressure, during maneuvers applied to multiple swine subjects to perturb blood pressure and vascular resistance. These behaviors provide insight into feasibility and robustness of cardiovascular property identification by multi-modal non-invasive wearable sensing. This is found to help refine non-invasive blood pressure measurements and estimation of systemic vascular resistance (SVR) and blood pressure (BP) using selected features of sensor amplitude versus applied cuff pressure.
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Affiliation(s)
- Lu Wang
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Yingjie Cai
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Kevin Ward
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Kenn Oldham
- University of Michigan, Ann Arbor, Michigan, USA
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3
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Hautaniemi EJ, Tikkakoski AJ, Eräranta A, Kähönen M, Hämäläinen E, Turpeinen U, Huhtala H, Mustonen J, Pörsti IH. Liquorice ingestion attenuates vasodilatation via exogenous nitric oxide donor but not via β2-adrenoceptor stimulation. PLoS One 2019; 14:e0223654. [PMID: 31626649 PMCID: PMC6799927 DOI: 10.1371/journal.pone.0223654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 09/22/2019] [Indexed: 11/19/2022] Open
Abstract
We examined the effect of liquorice ingestion on haemodynamic responses to exogenous nitric oxide donor (nitroglycerin) and β2-adrenoceptor agonist (salbutamol), and 11β-hydroxysteroid dehydrogenase activity, in 21 volunteers and 21 reference subjects. Haemodynamic data was captured before and after sublingual nitroglycerin (0.25 mg) and inhaled salbutamol (400 μg) during orthostatic challenge utilising radial pulse wave analysis and whole-body impedance cardiography. The recordings were performed at baseline and following two weeks of liquorice intake (290-370 mg/d glycyrrhizin). Urinary cortisone and cortisol metabolites were examined. Liquorice intake elevated aortic systolic and diastolic blood pressure and systemic vascular resistance when compared with the reference group. Following research drug administration the liquorice-induced increase in systemic vascular resistance was observed in the presence of nitroglycerin (p<0.05) but no longer in the presence of salbutamol. Liquorice ingestion decreased cardiac chronotropic response to upright posture (p = 0.032) in unadjusted analysis, but when adjusted for age and sex the difference in the upright change in heart rate was no longer significant. The urinary cortisone to cortisol metabolite ratio decreased from 0.70 to 0.31 (p<0.001) after liquorice intake indicating significant inhibition of the 11β-hydroxysteroid dehydrogenase type 2. In the reference group the haemodynamic variables remained virtually unchanged. These results suggest that liquorice exposure impaired vasodilatation in vivo that was induced by exogenous nitric oxide donor but not that induced by β2-adrenoceptor stimulation. Trial registration: EU Clinical Trials Register 2006-002065-39 ClinicalTrials.gov NCT01742702.
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Affiliation(s)
- Elina J. Hautaniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti J. Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Arttu Eräranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Esa Hämäläinen
- HUSLAB, Helsinki University Hospital, Helsinki, Finland
- Department of Clinical Chemistry, Biomedicum, Helsinki University, Helsinki, Finland
| | | | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka H. Pörsti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- * E-mail:
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4
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Tikkakoski AJ, Kangas P, Suojanen L, Tahvanainen AM, Eräranta A, Kähönen MAP, Sipilä K, Mustonen JT, Pörsti IH. Salbutamol-induced Decrease in Augmentation Index is Related to the Parallel Increase in Heart Rate. Basic Clin Pharmacol Toxicol 2018; 123:161-173. [PMID: 29476697 DOI: 10.1111/bcpt.12988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/11/2018] [Indexed: 11/30/2022]
Abstract
The change in augmentation index following salbutamol inhalation has been applied to evaluate endothelial function. We examined the contribution of salbutamol-induced increase in heart rate to the observed decrease in augmentation index. Haemodynamics were recorded using whole-body impedance cardiography and continuous pulse wave analysis from tonometric radial blood pressure. All subjects (n = 335, mean age 46, body mass index 26, 48% men) were without medications with cardiovascular influences. The effects of salbutamol inhalation (0.4 mg) versus the endothelium-independent agent nitroglycerin resoriblet (0.25 mg) were examined during passive head-up tilt, as the haemodynamic influences of these compounds depend on body position. Salbutamol decreased augmentation index by ~3-4% units in supine and upright positions. Although salbutamol moderately increased cardiac index (+4.5%) and decreased systemic vascular resistance (-8.5%), the significant haemodynamic explanatory factors for decreased augmentation index in multivariate analysis were increased supine heart rate, and increased upright heart rate and decreased ejection duration (p < 0.001 for all, r2 = 0.36-0.37). Sublingual nitroglycerin decreased supine and upright augmentation index by ~15% units and ~23% units, respectively. The haemodynamic explanatory factors for these changes in multivariate analysis were increased heart rate, reduced ejection duration and reduced systemic vascular resistance (p ≤ 0.021 for all, r2 = 0.22-0.34). In conclusion, the lowering influence of salbutamol on augmentation index may be largely explained by increased heart rate, suggesting that this effect may not predominantly reflect endothelial function.
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Affiliation(s)
- Antti J Tikkakoski
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Pauliina Kangas
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Lauri Suojanen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Anna M Tahvanainen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Arttu Eräranta
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Mika A P Kähönen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Kalle Sipilä
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jukka T Mustonen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka H Pörsti
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Nazário Leão R, Silva PMD, Pocinho RM, Alves M, Virella D, Palma Reis R. Good agreement between echocardiography and impedance cardiography in the assessment of left ventricular performance in hypertensive patients. Clin Exp Hypertens 2017; 40:461-467. [PMID: 29172784 DOI: 10.1080/10641963.2017.1392558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Impedance cardiography (ICG) is a noninvasive hemodynamic monitoring tool which can define hypertensive patients' hemodynamic profiles and help to tailor antihypertensive therapy. This study assesses the concordance between ICG-derived indexes used to evaluate left ventricular performance and transthoracic echocardiography (TTE) in hypertensive patients. METHODS In this IMPEDDANS post-hoc analysis, the ICG-derived indexes are compared with TTE by Bland-Altman method. Statistical significance of the relationship between the values obtained was assessed by generalized linear mixed-effects models. RESULTS In supine position, Bland-Altman analysis showed good concordance for cardiac output (CO) (mean difference of 0.006 mL/min [-0.120; 0.133]), cardiac index (CI) (mean difference of 0.016 mL/min/m2 [-0.471; 0.504]), pre-ejection period (PEP) (mean difference of -0.216 ms [-4.510; 4.077]), left ventricular ejection time (LVET) (mean difference of -0.140 ms [-6.573; 6.293]), and systolic time ratio (STR) (mean difference of -0.00004 [-0.008; 0.008]). In orthostatic position, good concordance was found for CO (mean difference 0.028 mL/min [-2.036; 1.980]), CI (mean difference -0.012 mL/min/m2 [-1.063; 1.039]), and STR (mean difference -0.101 [0.296; 0.094]). No significant difference between methods was identified by the linear mixed-effects models. CONCLUSION The ICG-derived indexes CO, CI, PEP, LVET, and STR in supine position have good agreement with TTE. Therefore, ICG can be used to accurately evaluate left ventricular performance.
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Affiliation(s)
- Rodrigo Nazário Leão
- a Unidade Funcional Medicina 2, Hospital São José, Centro Hospitalar Lisboa Central-EPE , Lisboa , Portugal.,b NOVA Medical School, Universidade NOVA de Lisboa , Lisboa , Portugal
| | - Pedro Marques Da Silva
- b NOVA Medical School, Universidade NOVA de Lisboa , Lisboa , Portugal.,c Núcleo de Investigação Arterial, Unidade Funcional Medicina 4, Hospital Santa Marta, Centro Hospitalar Lisboa Central-EPE , Lisboa , Portugal
| | - Rita Marques Pocinho
- a Unidade Funcional Medicina 2, Hospital São José, Centro Hospitalar Lisboa Central-EPE , Lisboa , Portugal
| | - Marta Alves
- d Gabinete de Análise Epidemiológica e Estatística, Centro de Investigação, Centro Hospitalar de Lisboa Central-EPE , Lisboa , Portugal
| | - Daniel Virella
- f Gabinete de Análise Epidemiológica e Estatística, Centro de Investigação, Centro Hospitalar Lisboa Central-EPE , Lisboa , Portugal
| | - Roberto Palma Reis
- b NOVA Medical School, Universidade NOVA de Lisboa , Lisboa , Portugal.,e Unidade de Cardiologia, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte-EPE , Lisboa , Portugal
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6
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Wilenius M, Tikkakoski AJ, Tahvanainen AM, Haring A, Koskela J, Huhtala H, Kähönen M, Kööbi T, Mustonen JT, Pörsti IH. Central wave reflection is associated with peripheral arterial resistance in addition to arterial stiffness in subjects without antihypertensive medication. BMC Cardiovasc Disord 2016; 16:131. [PMID: 27266507 PMCID: PMC4897906 DOI: 10.1186/s12872-016-0303-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/30/2016] [Indexed: 12/22/2022] Open
Abstract
Background Augmentation index, a marker of central wave reflection, is influenced by age, sex, height, blood pressure, heart rate, and arterial stiffness. However, the detailed haemodynamic determinants of augmentation index, and their relations, remain uncertain. We examined the association of augmentation index with vascular resistance and other haemodynamic and non-haemodynamic factors. Methods Background information, laboratory values, and haemodynamics of 488 subjects (239 men, 249 women) without antihypertensive medication were obtained. Indices of central wave reflection, systemic vascular resistance, cardiac function, and pulse wave velocity were measured using continuous radial pulse wave analysis and whole-body impedance cardiography. Results In a regression model including only haemodynamic variables, augmentation index in males and female subjects, respectively, was associated with systemic vascular resistance (β = 0.425, β = 0.336), pulse wave velocity (β = 0.409, β = 0.400) (P < 0.001 for all), stroke volume (β = 0.256, β = 0.278) (P = 0.001 for both) and heart rate (β = −0.150, β = −0.156) (P = 0.049 and P = 0.036). When age, height, weight, smoking habits, and laboratory values were included in the regression model, the most significant explanatory variables for augmentation index in males and females, respectively, were age (β = 0.577, β = 0.557) and systemic vascular resistance (β = 0.437, β = 0.295) (P < 0.001 for all). In the final regression model, pulse wave velocity was not a significant explanatory variable for augmentation index, probably due to the high correlation of this variable with age (Spearman’s correlation ≥0.617). Conclusion Augmentation index is strongly associated with systemic vascular resistance in addition to arterial stiffness. Trial registration ClinicalTrials.gov, NCT01742702. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0303-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matias Wilenius
- School of Medicine, Department of Internal Medicine, University of Tampere, Tampere, FIN-33014, Finland.
| | - Antti J Tikkakoski
- School of Medicine, Department of Internal Medicine, University of Tampere, Tampere, FIN-33014, Finland
| | - Anna M Tahvanainen
- School of Medicine, Department of Internal Medicine, University of Tampere, Tampere, FIN-33014, Finland
| | - Antti Haring
- School of Medicine, Department of Pharmacological Sciences, University of Tampere, Tampere, Finland
| | - Jenni Koskela
- School of Medicine, Department of Internal Medicine, University of Tampere, Tampere, FIN-33014, Finland
| | - Heini Huhtala
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Mika Kähönen
- School of Medicine, Department of Internal Medicine, University of Tampere, Tampere, FIN-33014, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Tiit Kööbi
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jukka T Mustonen
- School of Medicine, Department of Internal Medicine, University of Tampere, Tampere, FIN-33014, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka H Pörsti
- School of Medicine, Department of Internal Medicine, University of Tampere, Tampere, FIN-33014, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Yazdanian H, Mahnam A, Edrisi M, Esfahani MA. Design and Implementation of a Portable Impedance Cardiography System for Noninvasive Stroke Volume Monitoring. JOURNAL OF MEDICAL SIGNALS & SENSORS 2016; 6:47-56. [PMID: 27014612 PMCID: PMC4786963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/15/2016] [Indexed: 11/16/2022]
Abstract
Measurement of the stroke volume (SV) and its changes over time can be very helpful for diagnosis of dysfunctions in the blood circulatory system and monitoring their treatments. Impedance cardiography (ICG) is a simple method of measuring the SV based on changes in the instantaneous mean impedance of the thorax. This method has received much attention in the last two decades because it is noninvasive, easy to be used, and applicable for continuous monitoring of SV as well as other hemodynamic parameters. The aim of this study was to develop a low-cost portable ICG system with high accuracy for monitoring SV. The proposed wireless system uses a tetrapolar configuration to measure the impedance of the thorax at 50 kHz. The system consists of carefully designed precise voltage-controlled current source, biopotential recorder, and demodulator. The measured impedance was analyzed on a computer to determine SV. After evaluating the system's electronic performance, its accuracy was assessed by comparing its measurements with the values obtained from Doppler echocardiography (DE) on 5 participants. The implemented ICG system can noninvasively provide a continuous measure of SV. The signal to noise ratio of the system was measured above 50 dB. The experiments revealed that a strong correlation (r = 0.89) exists between the measurements by the developed system and DE (P < 0.05). ICG as the sixth vital sign can be measured simply and reliably by the developed system, but more detailed validation studies should be conducted to evaluate the system performance. There is a good promise to upgrade the system to a commercial version domestically for clinical use in the future.
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Affiliation(s)
- Hassan Yazdanian
- Department of Biomedical Engineering, University of Isfahan, Isfahan, Iran
| | - Amin Mahnam
- Department of Biomedical Engineering, University of Isfahan, Isfahan, Iran
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Edrisi
- Department of Electrical Engineering, University of Isfahan, Isfahan, Iran
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Kim BG, Cho SW, Lee HY, Kim DH, Byun YS, Goh CW, Rhee KJ, Kim BO. Reduced systemic vascular resistance is the underlying hemodynamic mechanism in nitrate-stimulated vasovagal syncope during head-up tilt-table test. J Arrhythm 2015; 31:196-200. [PMID: 26336559 DOI: 10.1016/j.joa.2014.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/21/2014] [Accepted: 11/26/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nitroglycerin (NTG) challenge during head-up tilt-table testing (HUTT) is often utilized to determine the etiology of unexplained vascular syncope. However, conflicting results concerning nitrate-induced hemodynamic changes during HUTT have been reported. The purpose of this study was to assess the determinants of presyncopal symptoms during NTG-stimulated HUTT. METHODS We evaluated 40 patients with suspected vasovagal syncope. Beat-to-beat changes in blood pressure, heart rate (HR), cardiac index (CI), and systemic vascular resistance (SVR) during HUTT were measured with thoracic impedance cardiography and a plethysmographic finger arterial pressure monitoring device. RESULTS None of the 40 patients complained of presyncopal symptoms during passive HUTT. However, after the administration of NTG 28 patients showed presyncopal symptoms (NTG+ group) and the remaining 12 patients did not (NTG- group). HR, CI, and the stroke index did not significantly differ between the two groups, whereas mean arterial pressure and SVR were significantly lower in the NTG+ group. CONCLUSIONS Presyncopal symptoms during NTG-stimulated HUTT are SVR mediated, not cardiac output mediated. This study challenges the conventional idea of a decrease in cardiac output mediated by NTG as the overriding cause of presyncopal symptoms during HUTT.
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Affiliation(s)
- Byung Gyu Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Sung Woo Cho
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea ; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Hye Young Lee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Deok Hee Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Choong Won Goh
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Kun Joo Rhee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
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Koźluk E, Cybulski G, Piątkowska A, Zastawna I, Niewiadomski W, Strasz A, Gąsiorowska A, Kempa M, Kozłowski D, Opolski G. Early hemodynamic response to the tilt test in patients with syncope. Arch Med Sci 2014; 10:1078-85. [PMID: 25624842 PMCID: PMC4296066 DOI: 10.5114/aoms.2014.47820] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/25/2013] [Accepted: 10/02/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Our aim was to evaluate the differences in the early hemodynamic response to the tilt test (HUTT) in patients with and without syncope using impedance cardiography (ICG). MATERIAL AND METHODS One hundred twenty-six patients (72 female/48 male; 37 ±17 years) were divided into a group with syncope (HUTT(+), n = 45 patients) and a group without syncope (HUTT(-), n = 81 patients). ECG and ICG signals were continuously recorded during the whole examination, allowing the calculation of heart rate (HR), stroke volume (SV), and cardiac output (CO) for every beat. The hemodynamic parameters (averaged over 1 min) were analyzed at the following points of the HUTT: the last minute of resting, the period immediately after the tilt (0 min), 1 min and 5 min after the maneuver. The absolute changes of HR, SV and CO were calculated for 0, 1, and 5 min after the maneuver in relation to the values at rest (ΔHR, ΔSV, ΔCO). Also, the percentage changes were calculated (HRi, SVi, COi). RESULTS There were no differences between the groups in absolute and percentage changes of hemodynamic parameters immediately after and 1 min after tilting. Significant differences between the HUTT(+) and HUTT(-) groups were observed in the 5(th) min of tilting: for ΔSV (-27.2 ±21.2 ml vs. -9.7 ±27.2 ml; p = 0.03), ΔCO (-1.78 ±1.62 l/min vs. -0.34 ±2.48 l/min; p = 0.032), COi (-30 ±28% vs. -0.2 ±58%; p = 0.034). CONCLUSIONS In the 5(th) min the decrease of hemodynamic parameters (ΔSV, ΔCO, COi) was significantly more pronounced in HUTT(+) patients in comparison to the HUTT(-) group.
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Affiliation(s)
- Edward Koźluk
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Gerard Cybulski
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- Institute of Metrology and Biomedical Engineering, Department of Mechatronics, Warsaw University of Technology, Warsaw, Poland
| | - Agnieszka Piątkowska
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Inga Zastawna
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
- Department and Clinic of Cardiac Rehabilitation and Noninvasive Electrocardiology, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Wiktor Niewiadomski
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- Chair and Department of Experimental and Clinical Physiology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Strasz
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Anna Gąsiorowska
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Kozłowski
- Department of Clinical Subjects, Institute of Health Sciences, Pomeranian University of Slupsk, Slupsk, Poland
| | - Grzegorz Opolski
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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10
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Hemodynamic alterations in hypertensive patients at rest and during passive head-up tilt. J Hypertens 2013; 31:906-15. [DOI: 10.1097/hjh.0b013e32835ed605] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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11
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Nichols WW, Harripersaud K, Petersen JW. Nitrates and Arterial Function. CURRENT CARDIOVASCULAR RISK REPORTS 2013. [DOI: 10.1007/s12170-013-0312-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Supine and upright haemodynamic effects of sublingual nitroglycerin and inhaled salbutamol. J Hypertens 2012; 30:297-306. [DOI: 10.1097/hjh.0b013e32834e4b26] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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