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Li Z, Chen X, He W, Chen H, Chen D. The causal effect of Alzheimer's disease and family history of Alzheimer's disease on non-ischemic cardiomyopathy and left ventricular structure and function: a Mendelian randomization study. Front Genet 2024; 15:1379865. [PMID: 38903751 PMCID: PMC11188370 DOI: 10.3389/fgene.2024.1379865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
Background Previous studies have shown that Alzheimer's disease (AD) can cause myocardial damage. However, whether there is a causal association between AD and non-ischemic cardiomyopathy (NICM) remains unclear. Using a comprehensive two-sample Mendelian randomization (MR) method, we aimed to determine whether AD and family history of AD (FHAD) affect left ventricular (LV) structure and function and lead to NICM, including hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). Methods The summary statistics for exposures [AD, paternal history of AD (PH-AD), and maternal history of AD (MH-AD)] and outcomes (NICM, HCM, DCM, and LV traits) were obtained from the large European genome-wide association studies. The causal effects were estimated using inverse variance weighted, MR-Egger, and weighted median methods. Sensitivity analyses were conducted, including Cochran's Q test, MR-Egger intercept test, MR pleiotropy residual sum and outlier, MR Steiger test, leave-one-out analysis, and the funnel plot. Results Genetically predicted AD was associated with a lower risk of NICM [odds ratio (OR) 0.9306, 95% confidence interval (CI) 0.8825-0.9813, p = 0.0078], DCM (OR 0.8666, 95% CI 0.7752-0.9689, p = 0.0119), and LV remodeling index (OR 0.9969, 95% CI 0.9940-0.9998, p = 0.0337). Moreover, genetically predicted PH-AD was associated with a decreased risk of NICM (OR 0.8924, 95% CI 0.8332-0.9557, p = 0.0011). MH-AD was also strongly associated with a decreased risk of NICM (OR 0.8958, 95% CI 0.8449-0.9498, p = 0.0002). Different methods of sensitivity analysis demonstrated the robustness of the results. Conclusion Our study revealed that AD and FHAD were associated with a decreased risk of NICM, providing a new genetic perspective on the pathogenesis of NICM.
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Affiliation(s)
| | | | | | | | - Dehai Chen
- Department of Cardiovascular Surgery, The First People’s Hospital of Zhaoqing, The First Affiliated Hospital of Zhaoqing Medical College, Zhaoqing, China
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Matthews EL, Sebzda KN, Wenner MM. Altered baroreflex sensitivity in young women with a family history of hypertension. J Neurophysiol 2019; 121:1011-1017. [PMID: 30673356 DOI: 10.1152/jn.00471.2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A positive family history of hypertension (+FH) is a risk factor for the future development of hypertension. Hypertension is associated with reductions in baroreflex sensitivity (BRS). Therefore, we hypothesized that young women with a +FH [ n = 12, 22 ± 1 yr, body mass index (BMI) 21 ± 1 kg/m2, mean arterial pressure (MAP) 79 ± 1 mmHg] would have lower BRS compared with young women without a family history of hypertension (-FH) ( n = 13, 22 ± 1 yr, BMI 21 ± 1 kg/m2, MAP 77 ± 2 mmHg, all P > 0.05 between groups). Continuous measurements of muscle sympathetic nerve activity, blood pressure, and electrocardiogram derived R-R interval were recorded at rest and during a Valsalva maneuver. Both cardiovagal BRS and vascular sympathetic BRS were assessed. Resting cardiovagal BRS was reduced in the +FH women (all sequences: -FH 32.3 ± 3.7 vs. +FH 20.2 ± 2.9 ms/mmHg, P = 0.02). Cardiovagal BRS during phase IV (-FH 16.5 ± 2.7 vs. +FH 7.6 ± 1.3 ms/mmHg, P < 0.01) but not phase II (-FH 5.5 ± 0.9 vs. +FH 5.0 ± 0.8 ms/mmHg, P = 0.67) of the Valsalva maneuver was also lower in the +FH women. Vascular sympathetic BRS at rest (-FH -2.38 ± 0.7 vs. +FH -2.33 ± 0.3 bursts· min-1·mmHg-1, P = 0.58) and during the Valsalva (-FH -0.74 ± 0.23 vs. +FH -0.66 ± 0.18 bursts·15 s-1·mmHg-1, P = 0.79) were not different between groups. These data suggest that healthy young women with a positive family history of hypertension have reduced cardiovagal BRS. This may be one mechanism contributing to the increased incidence of hypertension in this population later in life. NEW & NOTEWORTHY Having a family history of hypertension increases the risk of developing future hypertension. Reductions in baroreflex function have been demonstrated in hypertension and are an important marker for future cardiovascular disease. We show that young women with a family history of hypertension have lower cardiovagal baroreflex sensitivity. This alteration in autonomic function may be one mechanism contributing to the future incidence of hypertension in this patient population.
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Affiliation(s)
- Evan L Matthews
- Department of Kinesiology and Applied Physiology, University of Delaware , Newark, Delaware.,Exercise Science and Physical Education Department, Montclair State University , Montclair, New Jersey
| | - Kelly N Sebzda
- Department of Kinesiology and Applied Physiology, University of Delaware , Newark, Delaware
| | - Megan M Wenner
- Department of Kinesiology and Applied Physiology, University of Delaware , Newark, Delaware
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Jansen-Park SH, Mahmood MN, Müller I, Turnhoff LK, Schmitz-Rode T, Steinseifer U, Sonntag SJ. Effects of Interaction Between Ventricular Assist Device Assistance and Autoregulated Mock Circulation Including Frank-Starling Mechanism and Baroreflex. Artif Organs 2015; 40:981-991. [DOI: 10.1111/aor.12635] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- So-Hyun Jansen-Park
- Department of Cardiovascular Engineering; Institute of Applied Medical Engineering; Helmholtz Institute; RWTH Aachen University; Aachen Germany
| | - Mohammad Nauzef Mahmood
- Department of Cardiovascular Engineering; Institute of Applied Medical Engineering; Helmholtz Institute; RWTH Aachen University; Aachen Germany
| | - Indra Müller
- Department of Cardiovascular Engineering; Institute of Applied Medical Engineering; Helmholtz Institute; RWTH Aachen University; Aachen Germany
| | - Lisa Kathrin Turnhoff
- Department of Cardiovascular Engineering; Institute of Applied Medical Engineering; Helmholtz Institute; RWTH Aachen University; Aachen Germany
| | - Thomas Schmitz-Rode
- Department of Cardiovascular Engineering; Institute of Applied Medical Engineering; Helmholtz Institute; RWTH Aachen University; Aachen Germany
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering; Institute of Applied Medical Engineering; Helmholtz Institute; RWTH Aachen University; Aachen Germany
| | - Simon Johannes Sonntag
- Department of Cardiovascular Engineering; Institute of Applied Medical Engineering; Helmholtz Institute; RWTH Aachen University; Aachen Germany
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Gupta A, Jain G, Kaur M, Jaryal AK, Deepak KK, Bhowmik D, Agarwal SK. Association of impaired baroreflex sensitivity and increased arterial stiffness in peritoneal dialysis patients. Clin Exp Nephrol 2015; 20:302-8. [DOI: 10.1007/s10157-015-1158-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/18/2015] [Indexed: 01/08/2023]
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Effects of citalopram on heart rate variability in women with generalized anxiety disorder. ARYA ATHEROSCLEROSIS 2015; 11:196-203. [PMID: 26405453 PMCID: PMC4568193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 02/03/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Heart rate variability (HRV) is defined as variations in R-R interval with time. Dysautonomia is common in patients with psychiatric disorders such as depression and anxiety. Using HRV analysis, recent studies showed that in anxiety disorders, the vagal cardiac function decreases, and sympathetic function increases. This study aimed at investigating citalopram effects on HRV. METHODS This before and after study was conducted in 25 generalized anxiety disorder (GAD) patients. GAD was diagnosed based on clinical interview according to diagnostic and statistical manual of mental disorders IV-Text revised (DSM-IV-TR) criteria using Structured Clinical Interview for DSM Disorders-I questionnaire. A cardiologist studied 24 h ambulatory monitoring of the electrocardiogram (Holter) on all patients before the treatment. A volume of 20 mg of citalopram was administered to the subjects on a daily basis. Then, they were studied by Holter monitoring again after 1-month of administration of citalopram. RESULTS The average age of participants was 35.32 ± 8.7. The average Holter monitoring time was 23.29 ± 1.14 h before treatment and 23.81 ± 0.68 after it. The 3 h low frequency/high frequency ratio was significantly different between 3 h segments of time before treatment (P < 0.001). This difference was even higher after treatment (P = 0.001). Data showed an increase in parasympathetic tone during sleep both before and after treatment. CONCLUSION These patients showed some impairments of HRV indices that did not improve by citalopram in future, the clinical importance of such disturbances should be evaluated in details with prolonged follow-up and greater sample size.
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Pezawas T, Diedrich A, Winker R, Robertson D, Richter B, Wang L, Byrne DW, Schmidinger H. Multiple autonomic and repolarization investigation of sudden cardiac death in dilated cardiomyopathy and controls. Circ Arrhythm Electrophysiol 2014; 7:1101-8. [PMID: 25262115 DOI: 10.1161/circep.114.001745] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prophylactic defibrillator implantation is recommended in dilated, nonischemic heart disease and left ventricular ejection fraction of ≤0.30 to 0.35. Noninvasive testing should improve accuracy in decision making of prophylactic defibrillator implantation. METHODS AND RESULTS We enrolled 60 patients (median age, 57 years) with dilated cardiomyopathy and left ventricular ejection fraction ≤0.50, and 30 control subjects (median age, 59 years) with left ventricular ejection fraction >0.50. The protocol included an initial assessment, a second assessment after 3 years, and a final follow-up: pharmacological baroreflex testing (baroreceptor reflex sensitivity), short-term spectral analysis of heart rate variability (low frequency/high frequency), and long-term time domain analysis (SD of all normal-to-normal R-R intervals), exercise microvolt T wave alternans, and signal-averaged ECG, and corrected QT-time. The median follow-up was 7 years. End points were cardiac death, resuscitated cardiac arrest, and arrhythmic death. Cardiac death was observed in 21 patients. Resuscitated cardiac arrest and arrhythmic death caused by ventricular tachyarrhythmias ≥240 per minute was observed in 7 and 10 patients, respectively. In the single time point analysis, microvolt T wave alternans, baroreceptor reflex sensitivity, and SD of all normal-to-normal R-R intervals at initial testing added significant information regarding cardiac death. Microvolt T wave alternans added information on resuscitated cardiac arrest or arrhythmic death at multiple time points (P<0.001). False-negative microvolt T wave alternans results were seen in 8% of patients. CONCLUSIONS Noninvasive testing and left ventricular ejection fraction could not reliably identify patients with dilated cardiomyopathy at risk of fatal ventricular tachyarrhythmias. Therefore, the strategy to confine prophylactic implantable cardioverter-defibrillator implantation to patients with dilated cardiomyopathy and severely reduced LV function should be reconsidered.
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Affiliation(s)
- Thomas Pezawas
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (T.P., B.R., H.S.); Departments of Medicine (A.D.), and Departments of Medicine, Pharmacology, Neurology (D.R.), Division of Clinical Pharmacology, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN; Health and Prevention Center, Sanatorium Hera, Vienna, Austria (R.W.); and Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN (L.W., D.W.B.).
| | - André Diedrich
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (T.P., B.R., H.S.); Departments of Medicine (A.D.), and Departments of Medicine, Pharmacology, Neurology (D.R.), Division of Clinical Pharmacology, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN; Health and Prevention Center, Sanatorium Hera, Vienna, Austria (R.W.); and Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN (L.W., D.W.B.)
| | - Robert Winker
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (T.P., B.R., H.S.); Departments of Medicine (A.D.), and Departments of Medicine, Pharmacology, Neurology (D.R.), Division of Clinical Pharmacology, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN; Health and Prevention Center, Sanatorium Hera, Vienna, Austria (R.W.); and Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN (L.W., D.W.B.)
| | - David Robertson
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (T.P., B.R., H.S.); Departments of Medicine (A.D.), and Departments of Medicine, Pharmacology, Neurology (D.R.), Division of Clinical Pharmacology, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN; Health and Prevention Center, Sanatorium Hera, Vienna, Austria (R.W.); and Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN (L.W., D.W.B.)
| | - Bernhard Richter
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (T.P., B.R., H.S.); Departments of Medicine (A.D.), and Departments of Medicine, Pharmacology, Neurology (D.R.), Division of Clinical Pharmacology, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN; Health and Prevention Center, Sanatorium Hera, Vienna, Austria (R.W.); and Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN (L.W., D.W.B.)
| | - Li Wang
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (T.P., B.R., H.S.); Departments of Medicine (A.D.), and Departments of Medicine, Pharmacology, Neurology (D.R.), Division of Clinical Pharmacology, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN; Health and Prevention Center, Sanatorium Hera, Vienna, Austria (R.W.); and Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN (L.W., D.W.B.)
| | - Daniel W Byrne
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (T.P., B.R., H.S.); Departments of Medicine (A.D.), and Departments of Medicine, Pharmacology, Neurology (D.R.), Division of Clinical Pharmacology, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN; Health and Prevention Center, Sanatorium Hera, Vienna, Austria (R.W.); and Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN (L.W., D.W.B.)
| | - Herwig Schmidinger
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (T.P., B.R., H.S.); Departments of Medicine (A.D.), and Departments of Medicine, Pharmacology, Neurology (D.R.), Division of Clinical Pharmacology, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN; Health and Prevention Center, Sanatorium Hera, Vienna, Austria (R.W.); and Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN (L.W., D.W.B.)
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Patel BM, Bhadada SV. Type 2 diabetes-induced cardiovascular complications: comparative evaluation of spironolactone, atenolol, metoprolol, ramipril and perindopril. Clin Exp Hypertens 2013; 36:340-7. [DOI: 10.3109/10641963.2013.827699] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Alici G, Ozkan B, Acar G, Sahin M, Yazicioglu MV, Bulut M, Kiraz OG, Esen AM. Evaluation of autonomic functions by heart rate variability after stenting in patients with carotid artery stenosis. Ann Noninvasive Electrocardiol 2013; 18:126-9. [PMID: 23530482 DOI: 10.1111/anec.12054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Although carotid stenting is an effective treatment for severe carotid stenosis, it has been associated with alterations in autonomic functions during or shortly after the procedure. Heart rate variability (HRV) is an established tool for the asessment of autonumic functions. In this study, our aim was to investigate the relation between the alterations in autonomic functions and HRV by Holter monitoring parameters. METHODS Patients (19 male, 8 female) that are suitable for carotid artery stenting, without a history of hypertension, diabetes mellitus, severe coronary artery or valvular heart disease, were enrolled to our study. Short-term HRV analysis recordings were obtained at the beginning, and after the procedure. The square root of the mean squared differences of successive NN intervals (RMSSD), total frequency, low frequency (LF), high frequency (HF), normalized units LF (LFnu), normalized units HF (HFnu), LF/HF ratios were analyzed. Results were statistically analysed by using Wilcoxon test. RESULTS Total frequency did not show any significant changes after the procedure (1101 ± 829, 981 ± 855). While RMSSD and HFnu values significantly increased respectively (23 ± 12/33 ± 22, and 22 ± 10/35 ± 10, p < 0.05) after the procedure, HF values increased nonsignificantly after the procedure (82 ± 92/92 ± 108). LF, LFnu, and LF/HF values were significantly decreased after the procedure. (228 ± 166/112 ± 100, 70 ± 15/55 ± 18, 4 ± 2.5/2.1 ± 2, respectively, p < 0.05) CONCLUSIONS While RMSSD and HF are used as markers of vagal activity, LF is a marker of sympathetic modulation and LF/HF ratio shows sympathovagal balance. In our study, we showed that carotid artery stenting is associated with increase in parasympathetic activation, and this finding is demonstrated by HRV parameters.
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Affiliation(s)
- Gokhan Alici
- Department of Cardiology, Kartal Kosuyolu Yuksek Ihtisas Hospital, Istanbul, Turkey 34865.
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Huang CC, Wu YS, Chen T, Chang WN, Du YC, Wu CJ, Yip HK, Tsai NW, Tan TY, Chuang YC, Wang HC, Lu CH. Long-term effects of baroreflex function after stenting in patients with carotid artery stenosis. Auton Neurosci 2010; 158:100-4. [DOI: 10.1016/j.autneu.2010.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 04/24/2010] [Accepted: 06/21/2010] [Indexed: 10/19/2022]
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10
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Investigation Into the Cardiac Effects of Spironolactone in the Experimental Model of Type 1 Diabetes. J Cardiovasc Pharmacol 2009; 54:502-9. [DOI: 10.1097/fjc.0b013e3181be75cc] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Predictive value of cardiac autonomic indexes and MIBG washout in ICD recipients with mild to moderate heart failure. Ann Nucl Med 2009; 23:677-84. [DOI: 10.1007/s12149-009-0289-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 07/07/2009] [Indexed: 01/08/2023]
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La Rovere MT, Pinna GD, Raczak G. Baroreflex sensitivity: measurement and clinical implications. Ann Noninvasive Electrocardiol 2008; 13:191-207. [PMID: 18426445 DOI: 10.1111/j.1542-474x.2008.00219.x] [Citation(s) in RCA: 395] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Alterations of the baroreceptor-heart rate reflex (baroreflex sensitivity, BRS) contribute to the reciprocal reduction of parasympathetic activity and increase of sympathetic activity that accompany the development and progression of cardiovascular diseases. Therefore, the measurement of the baroreflex is a source of valuable information in the clinical management of cardiac disease patients, particularly in risk stratification. This article briefly recalls the pathophysiological background of baroreflex control, and reviews the most relevant methods that have been developed so far for the measurement of BRS. They include three "classic" methods: (i) the use of vasoactive drugs, particularly the alpha-adrenoreceptor agonist phenylephrine, (ii) the Valsalva maneuver, which produces a natural challenge for the baroreceptors by voluntarily increasing intrathoracic and abdominal pressure through straining, and (iii) the neck chamber technique, which allows a selective activation/deactivation of carotid baroreceptors by application of a negative/positive pressure to the neck region. Two more recent methods based on the analysis of spontaneous oscillations of systolic arterial pressure and RR interval are also reviewed: (i) the sequence method, which analyzes the relationship between increasing/decreasing ramps of blood pressure and related increasing/decreasing changes in RR interval through linear regression, and (ii) spectral methods, which assess the relationship (in terms of gain) between specific oscillatory components of the two signals. The limitations of the coherence criterion for the computation of spectral BRS are discussed, and recent proposals for overcoming them are presented. Most relevant clinical applications of BRS measurement are finally reviewed with particular reference to patients with myocardial infarction and heart failure.
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Affiliation(s)
- Maria Teresa La Rovere
- Department of Cardiology, S. Maugeri Foundation-IRCCS, Scientific Institute of Mentescano, Montescano (PV), Italy.
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Wessel N, Malberg H, Heringer-Walther S, Schultheiss HP, Walther T. The Angiotensin-(1-7) Receptor Agonist AVE0991 Dominates the Circadian Rhythm and Baroreflex in Spontaneously Hypertensive Rats. J Cardiovasc Pharmacol 2007; 49:67-73. [PMID: 17312445 DOI: 10.1097/fjc.0b013e31802cffe9] [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] [Indexed: 01/24/2023]
Abstract
Because we previously suggested the endogenous heptapeptide angiotensin (Ang)-(1-7) to be involved in the improvement of baroreflex sensitivity observed in spontaneously hypertensive rats (SHR), we here investigated the role of the heptapeptide in blood pressure control under physiologic conditions in awake SHR using the first nonpeptide, orally applicable Ang-(1-7) receptor agonist AVE0991 by telemetry. Five weeks after the start of treatment the blood pressure signals (500 Hz) were monitored in 10 untreated and 6 age-matched male SHR treated by AVE0991 for 24 hours (every 2 hours for 10 minutes). The autonomous tone was estimated from the heart rate and blood pressure variability (HRV, BPV) and from the spontaneous baroreceptor sensitivity (BRS).AVE0991 treatment blunted the rodent-characterizing nightly increase in blood pressure and led to pronounced changes in the BPV and HRV parameters during the night in comparison to untreated controls (eg, sdNN: AVE0991=8.19 versus control=11.5 mm Hg; P<0.001). However, even more significant differences were detected for BRS. Whereas the average slope did not alter, the activation of the baroreflexes (P<10E-6) and the number of baroreflex fluctuations were reduced dramatically by AVE0991 (P<10E-5). The data obtained pointed to an abating impact of AVE0991 on the baroreceptor in SHR and to its influence on the circadian rhythm, thus implying a direct involvement of Ang-(1-7) in cardiovascular control.
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Affiliation(s)
- N Wessel
- Department of Physics, University of Potsdam, Germany
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Baumert M, Brechtel L, Lock J, Hermsdorf M, Wolff R, Baier V, Voss A. Heart rate variability, blood pressure variability, and baroreflex sensitivity in overtrained athletes. Clin J Sport Med 2006; 16:412-7. [PMID: 17016118 DOI: 10.1097/01.jsm.0000244610.34594.07] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the effects of abruptly intensified physical training on cardiovascular control. DESIGN Retrospective longitudinal study. SETTING Research laboratory. PARTICIPANTS Ten healthy athletes (5 men and 5 women) from track and field as well as triathlon. INTERVENTIONS A 2-week training camp, including daily stepwise increasing cycling tests, running of 40 minutes, and additional cycling of 60 minutes. MAIN OUTCOME MEASUREMENTS Time and frequency domain parameters of resting heart rate and blood pressure variability (HRV and BPV) and baroreflex sensitivity (BRS), before, during, and after the training camp. RESULTS We found significantly reduced HRV during the training camp (mean beat-to-beat interval: 1042 [937 to 1194] ms vs. 933 [832 to 1103] ms vs. 1055 [947 to 1183] ms, P < 0.01; root-mean-square of beat-to-beat interval differences: 68 [52 to 95] ms vs. 52 [38 to 71] ms vs. 61 [48 to 78] ms, P < 0.05). Further, BRS was significantly reduced: 25.2 (20.4 to 40.4) ms/mmHg vs. 17.0 (12.9 to 25.7) ms/mmHg vs. 25.7 (18.8 to 29.1) ms/mmHg, P < 0.05. These effects disappeared at a large degree after 3 to 4 days of recovery. CONCLUSION Abruptly intensified physical training results in an altered autonomic cardiovascular activity towards parasympathetic inhibition and sympathetic activation that can be monitored by means of HRV and BRS analyses and might provide useful markers to avoid the overtraining syndrome.
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Affiliation(s)
- Mathias Baumert
- Department of Medical Engineering, University of Applied Sciences Jena, Germany.
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Bullinga JR, Alharethi R, Schram MS, Bristow MR, Gilbert EM. Changes in Heart Rate Variability Are Correlated to Hemodynamic Improvement With Chronic CARVEDILOL Therapy in Heart Failure. J Card Fail 2005; 11:693-9. [PMID: 16360965 DOI: 10.1016/j.cardfail.2005.06.435] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Revised: 06/03/2005] [Accepted: 06/17/2005] [Indexed: 12/01/2022]
Abstract
BACKGROUND Reduced heart rate variability (HRV) has been shown to predict mortality in heart failure (CHF). The relationship between improved cardiac function and improvement in HRV has not been previously studied. METHODS AND RESULTS This was substudy of a randomized, placebo-controlled, double-blinded trial of carvedilol of four months duration. Analysis of HRV was performed on 24-hour Holter monitors obtained at baseline and completion of study. All subjects had symptomatic CHF and an left ventricular ejection fraction (LVEF) <0.35. Study medication was titrated over 1 month to 50 mg/day (< or =75 kg) or 100 mg/day (<75 kg). A total of 17 subjects were randomized to carvedilol and 12 to placebo. Treatment with carvedilol was associated with significant increases in total frequency power, very low frequency power, high frequency power, SDNN, the root-mean square of difference of successive RRs, and pNN50. Change in time and frequency domain measures of HRV had a positive correlation with change in LVEF and negative correlation with change in coronary sinus norepinephrine levels. CONCLUSION Carvedilol therapy in patients with CHF significantly increased HRV. Change in HRV correlates to improved hemodynamics. This suggests that carvedilol therapy partially normalizes autonomic modulation of heart rate in patients with CHF.
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Affiliation(s)
- John R Bullinga
- Division of Cardiology, New York University, New York, NY, USA
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Shekha K, Ghosh J, Thekkoott D, Greenberg Y. Risk stratification for sudden cardiac death in patients with non-ischemic dilated cardiomyopathy. Indian Pacing Electrophysiol J 2005; 5:122-38. [PMID: 16943952 PMCID: PMC1502083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Non ischemic dilated cardiomyopathy (NIDCM) is a disorder of myocardium. It has varying etiologies. Albeit the varying etiologies of this heart muscle disorder, it presents with symptoms of heart failure, and rarely as sudden cardiac death (SCD). Manifestations of this disorder are in many ways similar to its counterpart, ischemic dilated cardiomyopathy (IDCM). A proportion of patients with NIDCM carries a grave prognosis and is prone to sudden cardiac death from sustained ventricular arrhythmias. Identification of this subgroup of patients who carry the risk of sudden cardiac death despite adequate medical management is a challenge. Yet another method is a blanket treatment of patients with this disorder with anti arrhythmic medications or anti tachyarrhythmia devices like implantable cardioverter defibrillators (ICD). However this modality of treatment could be a costly exercise even for affluent economies. In this review we try to analyze the existing data of risk stratification of NIDCM and its clinical implications in practice.
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Affiliation(s)
- Karthik Shekha
- Department of Cardiology and Clinical Electrophysiology, Maimonides Medical Center (Mount Sinai Health System), Brooklyn, New York 11219, USA
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Desai N, Raghunandan DS, Mallavarapu M, Berger RD, Yeragani VK. Beat-to-beat heart rate and QT variability in patients with congestive cardiac failure: blunted response to orthostatic challenge. Ann Noninvasive Electrocardiol 2005; 9:323-9. [PMID: 15485509 PMCID: PMC6932188 DOI: 10.1111/j.1542-474x.2004.94559.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Congestive cardiac failure is associated with increased sympathetic activity and impaired baroreflex function. We sought to test the hypothesis that these patients also have blunted response of beat-to-beat QT interval variability during orthostatic challenge. METHODS We compared beat-to-beat heart rate and QT interval data in 17 patients with congestive cardiac failure and 17 age-matched normal controls in supine normal breathing, supine controlled breathing, and standing controlled breathing conditions. The ECG data were acquired in lead II configuration at a sampling rate of 1000 Hz. RESULTS Supine controlled breathing was associated with an increase in spectral HF power (0.15-0.5 Hz) of HR and QT interval time series compared to spontaneous breathing condition only in controls. While there were significant changes in HR, HR LF power, HR LF/HF ratios, and QT variability measures in standing posture in controls, there were no such changes in patients. CONCLUSIONS This impairment of postural changes of HR variability is most likely due to an impaired baroreceptor function in patients with congestive heart failure. The etiology of this is likely due to an increased cardiac sympathetic and a decreased vagal function. However, the relationship of postural changes in beat-to-beat QT interval variability and baroreflex need further investigation.
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Affiliation(s)
- Nagaraj Desai
- Department of Cardiology, M.S. Ramaiah Medical College Hospital, Bangalore, India
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Zamaklar-Trifunović D, Seferović PM, Zivković M, Jelić V, Vukomanović G, Petrović M, Milić N, Ristić AD, Simeunović D. Influence of heart failure severity on heart rate variability. SRP ARK CELOK LEK 2005; 133:484-91. [PMID: 16758848 DOI: 10.2298/sarh0512484z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction. Autonomic regulation of cardiovascular functions in congestive heart failure is characterised by enhanced sympathetic and diminished parasympathetic activity. The long term predominance of sympathetic tone is a significant factor in arrhythmogenesis, sudden cardiac death, and progressive pump failure. Heart rate variability (HRV) is a noninvasive method for estimating the sympatho vagal balance in cardiovascular control. Aim. The aim of this study was to analyse the influence of heart failure severity on HRV. Method. HRV was estimated through the spectral analysis of short term ECG (Cardiovit AT 60, Schiller, CH) in 63 patients (78% male, mean age 56.9?10.9 years) and 14 healthy volunteers (57.1% male, mean age 53.1?8.2 years). The following spectral components were measured: VLF (very low frequency), LF (low frequency), HF (high frequency), and total power (Tot Power). Results. All spectral components were statistically, significantly lower in patients with heart failure in comparison to healthy controls (VLF: 159.89?147.02 vs. 285.50?202.77 ms2; p=0.023, LF: 161.48?204.01 vs. 474.57?362.93 ms2; p<0.001, HF: 88.58?102.47 vs. 362.71?318.28 ms2; p<0.001), as well as total power (Tot Power: 723.39?644.52 vs. 1807.29?1204.74 ms2; p<0.001). A significant, negative correlation between HRV parameters and NYHA class was detected in heart failure patients (VLF: r=-0.391; p=0.002, LF: r=-0.401; p=0.001, and Tot Power r=-0.372; p=0.003). Ejection fraction proved to be in significant, positive correlation to VLF (r=0.541; p=0.002), LF (r=0.531; p=0.003), HF (r=0.418; p=0.020), and Tot Power (r=0.457; p=0.013). Conclusion. Significant HRV reduction is a precursor to incipient heart failure (NYHA I). In heart failure progression, total power as well as the power of all spectral components is progressively reduced. LF and Tot Power are the most prominent parameters for discriminating between the different stages of heart failure. These results could promote HRV as an important decision-making tool in heart failure treatment as well as in monitoring the results of that treatment.
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Hohnloser SH, Klingenheben T, Bloomfield D, Dabbous O, Cohen RJ. Usefulness of microvolt T-wave alternans for prediction of ventricular tachyarrhythmic events in patients with dilated cardiomyopathy: results from a prospective observational study. J Am Coll Cardiol 2003; 41:2220-4. [PMID: 12821251 DOI: 10.1016/s0735-1097(03)00467-4] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This study was designed to evaluate the ability of microvolt-level T-wave alternans (MTWA) to identify prospectively patients with idiopathic dilated cardiomyopathy (DCM) at risk of ventricular tachyarrhythmic events and to compare its predictive accuracy with that of conventional risk stratifiers. BACKGROUND Patients with DCM are at increased risk of sudden death from ventricular tachyarrhythmias. At present, there are no established methods of assessing this risk. METHODS A total of 137 patients with DCM underwent risk stratification through assessment of MTWA, left ventricular ejection fraction, baroreflex sensitivity (BRS), heart rate variability, presence of nonsustained ventricular tachycardia (VT), signal-averaged electrocardiogram, and presence of intraventricular conduction defect. The study end point was either sudden death, resuscitated ventricular fibrillation, or documented hemodynamically unstable VT. RESULTS During an average follow-up of 14 +/- 6 months, MTWA and BRS were significant univariate predictors of ventricular tachyarrhythmic events (p < 0.035 and p < 0.015, respectively). Multivariate Cox regression analysis revealed that only MTWA was a significant predictor. CONCLUSIONS Microvolt-level T-wave alternans is a powerful independent predictor of ventricular tachyarrhythmic events in patients with DCM.
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Grimm W, Liedtke J, Müller HH. Prevalence of potential noninvasive arrhythmia risk predictors in healthy, middle-aged persons. Ann Noninvasive Electrocardiol 2003; 8:37-46. [PMID: 12848812 PMCID: PMC6932519 DOI: 10.1046/j.1542-474x.2003.08107.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To date, prevalence and clinical significance of noninvasive arrhythmia risk predictors in apparently healthy, middle-aged persons are largely unknown. METHODS A total of 110 apparently healthy persons 20-75 years old were enrolled in this prospective observational monocenter study and followed up for 32 +/- 15 months. Baseline investigations included symptom-limited bicycle ergometry, echocardiography, time-domain analysis, and spectral turbulence analysis of the signal-averaged electrocardiogram (ECG), ventricular arrhythmias, and heart rate variability on 24-hour Holter ECG, baroreflex sensitivity, and t-wave alternans in all persons. RESULTS The prevalence of an abnormal signal-averaged ECG was 1% for spectral turbulence analysis and varied between 1% and 37% for time-domain analysis depending upon the definition used for an abnormal time-domain analysis. A reduced heart rate variability defined as a standard deviation of normal-to-normal intervals < or =105 ms, <100 ms and <70 ms was found in 12%, 9%, and 1% of persons. A baroreflex sensitivity <6 ms/mmHg and <3 ms/mmHg was present in 15% and 2% of persons. Microvolt t-wave alternans was found to be positive in 5%, negative in 88%, and indeterminate in 7% of persons, respectively. During the 32 +/- 15 months follow-up, no arrhythmic events and no cardiovascular mortality were observed in this population. CONCLUSIONS Abnormal findings of noninvasive arrhythmia risk stratification can be found in 1-37% of healthy, middle-aged persons when previously reported cut-off values are used.
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Affiliation(s)
- Wolfram Grimm
- Department of Cardiology, Hospital of the Philipps-University of Marburg, Marburg, Germany.
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Lucini D, Guzzetti S, Casiraghi S, Pagani M. Correlation between baroreflex gain and 24-h indices of heart rate variability. J Hypertens 2002; 20:1625-31. [PMID: 12172325 DOI: 10.1097/00004872-200208000-00026] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the relationship between heart rate variability (HRV) and baroreflex sensitivity (BRS). DESIGN An observational study, with no intervention, in 55 volunteers with a wide range of arterial pressure (60-90/115-185 mmHg). METHODS Volunteers were studied first in the laboratory, with continuous measurement of systolic arterial pressure and electrocardiogram to obtain a frequency domain measure of baroreflex sensitivity (index alpha). Immediately afterwards, while the individual was ambulant, a Holter recording was obtained in order to compute time domain [standard deviation of consecutive normal R-R intervals (SDNN) and the percentage of successive R-R differences > 50 ms (PNN50)], and frequency domain measures of HRV. Linear correlation was used to test the statistical link between index alpha and HRV indices. RESULTS Significant correlations were observed between index alpha and SDNN (r = 0.30; P < 0.02) and PNN50 (r = 0.48; P < 0.001), and between index alpha and total power (r = 0.53; P < 0.001), and absolute powers of the 0.0001-0.04 Hz components of R-R interval variability in 24 h (r = 0.47; P < 0.001). CONCLUSION The major findings of this study are the clear demonstration of a significant correlation between a laboratory measure of baroreflex sensitivity and 24 h measures of HRV, obtained immediately afterwards. Notably, this correlation was found with both time domain and absolute, but not normalized, spectral measures of R-R interval variability. In addition, different levels of individual activity, as assessed by separate examination of daytime and night-time periods, did not seem to influence this relationship.
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Affiliation(s)
- Daniela Lucini
- Centro di Ricerca sulla Terapia Neurovegetativa, Istituto Scienze Biomediche, University of Milan, Milan, Italy
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