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A Methodological Perspective on the Function and Assessment of Peripheral Chemoreceptors in Heart Failure: A Review of Data from Clinical Trials. Biomolecules 2022; 12:biom12121758. [PMID: 36551186 PMCID: PMC9775522 DOI: 10.3390/biom12121758] [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: 11/04/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Augmented peripheral chemoreceptor sensitivity (PChS) is a common feature of many sympathetically mediated diseases, among others, and it is an important mechanism of the pathophysiology of heart failure (HF). It is related not only to the greater severity of symptoms, especially to dyspnea and lower exercise tolerance but also to a greater prevalence of complications and poor prognosis. The causes, mechanisms, and impact of the enhanced activity of peripheral chemoreceptors (PChR) in the HF population are subject to intense research. Several methodologies have been established and utilized to assess the PChR function. Each of them presents certain advantages and limitations. Furthermore, numerous factors could influence and modulate the response from PChR in studied subjects. Nevertheless, even with the impressive number of studies conducted in this field, there are still some gaps in knowledge that require further research. We performed a review of all clinical trials in HF human patients, in which the function of PChR was evaluated. This review provides an extensive synthesis of studies evaluating PChR function in the HF human population, including methods used, factors potentially influencing the results, and predictors of increased PChS.
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Guckel D, Eitz T, El Hamriti M, Braun M, Khalaph M, Imnadze G, Fink T, Sciacca V, Sohns C, Sommer P, Nölker G. Baroreflex activation therapy in advanced heart failure therapy: insights from a real-world scenario. ESC Heart Fail 2022; 10:284-294. [PMID: 36208130 PMCID: PMC9871720 DOI: 10.1002/ehf2.14190] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/01/2022] [Accepted: 09/21/2022] [Indexed: 01/29/2023] Open
Abstract
AIMS Baroreflex activation therapy (BAT) is an innovative treatment option for advanced heart failure (HFrEF). We analysed patients' BAT acceptance and the outcome of BAT patients compared with HFrEF patients solely treated with a guideline-directed medical therapy (GDMT) and studied effects of sacubitril/valsartan (ARNI). METHODS In this prospective study, 40 HFrEF patients (71 ± 3 years, 20% female) answered a questionnaire on the acceptance of BAT. Follow-up visits were performed after 3, 6, and 12 months. Primary efficacy endpoints included an improvement in QoL, NYHA class, LVEF, HF hospitalization, NT-proBNP levels, and 6MHWD. RESULTS Twenty-nine patients (73%) showed interest in BAT. Ten patients (25%) opted for implantation. BAT and BAT + ARNI patients developed an increase in LVEF (BAT +10%, P-value (P) = 0.005*; BAT + ARNI +9%, P = 0.049*), an improved NYHA class (BAT -88%, P = 0.014*, BAT + ARNI -90%, P = 0.037*), QoL (BAT +21%, P = 0.020*, BAT + ARNI +22%, P = 0.012*), and reduced NT-proBNP levels (BAT -24%, P = 0.297, BAT + ARNI -37%, P = 0.297). BAT HF hospitalization rates were lower (50%) compared with control group patients (83%) (P = 0.020*). CONCLUSIONS Although BAT has generated considerable interest, acceptance appears to be ambivalent. BAT improves outcome with regard to LVEF, NYHA class, QoL, NT-proBNP levels, and HF hospitalization rates. BAT + ARNI resulted in more pronounced effects than ARNI alone.
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Affiliation(s)
- Denise Guckel
- Clinic for ElectrophysiologyHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Thomas Eitz
- Clinic for Thoracic and Cardiovascular SurgeryHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Mustapha El Hamriti
- Clinic for ElectrophysiologyHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Martin Braun
- Clinic for ElectrophysiologyHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Moneeb Khalaph
- Clinic for ElectrophysiologyHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Guram Imnadze
- Clinic for ElectrophysiologyHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Thomas Fink
- Clinic for ElectrophysiologyHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Vanessa Sciacca
- Clinic for ElectrophysiologyHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Christian Sohns
- Clinic for ElectrophysiologyHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Philipp Sommer
- Clinic for ElectrophysiologyHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Georg Nölker
- Clinic for ElectrophysiologyHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany,Clinic for Internal Medicine II/CardiologyChristliches Klinikum Unna MitteUnnaGermany
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Zweerink A, Salden OA, van Everdingen WM, de Roest GJ, van de Ven PM, Cramer MJ, Doevendans PA, van Rossum AC, Vernooy K, Prinzen FW, Meine M, Allaart CP. Hemodynamic Optimization in Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2019; 5:1013-1025. [DOI: 10.1016/j.jacep.2019.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 11/16/2022]
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Liosis S, Lyan E, Abdin A, Brüggemann B, Lange SA, Vogler J, Heeger CH, Yalin K, Tilz RR, Eitel C. Biventricular Pacing Going Along with Acute Hemodynamic Response in a Patient with Huge Anterior Wall Aneurysm - Importance of Pacing Viable Myocardium. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:810-815. [PMID: 31177265 PMCID: PMC6581013 DOI: 10.12659/ajcr.914480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Patient: Female, 85 Final Diagnosis: Ischemic cardiomyopathy with electrical storm Symptoms: Dyspnea Medication: — Clinical Procedure: Ablation of ventricular tachycardia Specialty: Cardiology
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Affiliation(s)
- Spyridon Liosis
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Evgeny Lyan
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Amr Abdin
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Ben Brüggemann
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Stefan A Lange
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Julia Vogler
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Christian H Heeger
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Kivanc Yalin
- Department of Cardiology, Usak University, Faculty of Medicine, Usak, Turkey
| | - Roland R Tilz
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Charlotte Eitel
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
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McALOON CJ, Anderson BM, Dimitri W, Panting J, Yusuf S, Bhudia SK, Osman F. Long-Term Follow-Up of Isolated Epicardial Left Ventricular Lead Implant Using a Minithoracotomy Approach for Cardiac Resynchronization Therapy. Pacing Clin Electrophysiol 2016; 39:1052-1060. [PMID: 27501471 DOI: 10.1111/pace.12932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 07/20/2016] [Accepted: 07/31/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Transvenous left ventricular (LV) lead placement for cardiac resynchronization therapy is unsuccessful in 5-10% of reported cases. These patients may benefit from isolated surgical placement of an epicardial LV lead via minithoracotomy approach. AIM To evaluate the success of this approach at long-term follow-up. METHODS Retrospective evaluation of all consecutive patients undergoing isolated epicardial LV lead placement after failed transvenous attempt over a 6-year period. Data collected on baseline parameters, procedural details, and outcome at follow-up (hospital stay, complications, mortality, and clinical response). RESULTS Forty-two patients underwent epicardial lead implant. Five died within 1 year (11.9%): two (4.8%) died within 30-days post op (one from intraoperative hemorrhage, the other from multiple organ failure); 39 (95.1%) were admitted to the high dependency unit and transferred to the ward <24 hours. Median hospital stay was 3.4 ± 1.9 days. The overall complication rate was 17.5% (n = 7): 15.0% (n = 6) short term and 2.5% (n = 1) long term; these included three (7.5%) LV noncapture events all treated with reprogramming. There were two (5.0%) wound infections requiring oral antibiotics and two (5.0%) device infections requiring intravenous antibiotics (one had device resiting, the other developed septic shock requiring intensive care admission). Assessment of clinical response was possible in 34 (81.0%) at follow-up: 21 (61.8%) were responders and 13 (28.2%) nonresponders with no significant differences between these groups; no clinical predictors of response were identified. CONCLUSION Isolated epicardial LV lead implant using minithoracotomy is relatively safe and effective at successful LV pacing. Response rate and postoperative recovery at long-term follow-up are reasonable in these high-risk patients.
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Affiliation(s)
| | | | - Wadih Dimitri
- Department of Cardiology, University Hospital Coventry, Coventry, UK
| | - Jonathan Panting
- Department of Cardiology, Good Hope Hospital, Heart of England NHS Trust, Birmingham, UK
| | - Shamil Yusuf
- Department of Cardiology, Good Hope Hospital, Heart of England NHS Trust, Birmingham, UK
| | - Sunil K Bhudia
- Department of Cardiology, University Hospital Coventry, Coventry, UK
| | - Faizel Osman
- Department of Cardiology, University Hospital Coventry, Coventry, UK.
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Fernandes Serôdio J, Martins Oliveira M, Matoso Laranjo S, Tavares C, Silva Cunha P, Abreu A, Branco L, Alves S, Rocha I, Cruz Ferreira R. The arterial baroreflex effectiveness index in risk stratification of chronic heart failure patients who are candidates for cardiac resynchronization therapy. Rev Port Cardiol 2016; 35:343-50. [PMID: 27255174 DOI: 10.1016/j.repc.2015.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/22/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Baroreflex function is an independent marker of prognosis in heart failure (HF). However, little is known about its relation to response to cardiac resynchronization therapy (CRT). The aim of this study is to assess arterial baroreflex function in HF patients who are candidates for CRT. METHODS The study population consisted of 25 patients with indication for CRT, aged 65±10 years, NYHA functional class ≥III in 52%, QRS width 159±15 ms, left ventricular ejection fraction (LVEF) 29±5%, left ventricular end-systolic volume (LVESV) 150±48 ml, B-type natriuretic peptide (BNP) 357±270 pg/ml, and peak oxygen consumption (peak VO2) 18.4±5.0 ml/kg/min. An orthostatic tilt test was performed to assess the baroreflex effectiveness index (BEI) by the sequence method. This group was compared with 15 age-matched healthy individuals. RESULTS HF patients showed a significantly depressed BEI during tilt (31±12% vs. 49±18%, p=0.001). A lower BEI was associated with higher BNP (p=0.038), lower peak VO2 (p=0.048), and higher LVESV (p=0.031). By applying a cut-off value of 25% for BEI, two clusters of patients were identified: lower risk cluster (BEI >25%) QRS 153 ms, LVESV 129 ml, BNP 146 pg/ml, peak VO2 19.0 ml/kg/min; and higher risk cluster (IEB ≤25%) QRS 167 ms, LVESV 189 ml, BNP 590 pg/ml, peak VO2 16.2 ml/kg/min. CONCLUSIONS Candidates for CRT show depressed arterial baroreflex function. Lower BEI was observed in high-risk HF patients. Baroreflex function correlated closely with other clinical HF parameters. Therefore, BEI may improve risk stratification in HF patients undergoing CRT.
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Affiliation(s)
| | - Mário Martins Oliveira
- Institute of Physiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal; Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal
| | - Sérgio Matoso Laranjo
- Institute of Physiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Cristiano Tavares
- Institute of Physiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | | - Ana Abreu
- Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal
| | - Luísa Branco
- Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal
| | - Sandra Alves
- Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal
| | - Isabel Rocha
- Institute of Physiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Fernandes Serôdio J, Martins Oliveira M, Matoso Laranjo S, Tavares C, Silva Cunha P, Abreu A, Branco L, Alves S, Rocha I, Cruz Ferreira R. The arterial baroreflex effectiveness index in risk stratification of chronic heart failure patients who are candidates for cardiac resynchronization therapy. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Daniłowicz-Szymanowicz L, Suchecka J, Niemirycz-Makurat A, Rozwadowska K, Raczak G. Autonomic Predictors of Hospitalization Due to Heart Failure Decompensation in Patients with Left Ventricular Systolic Dysfunction. PLoS One 2016; 11:e0152372. [PMID: 27015089 PMCID: PMC4807762 DOI: 10.1371/journal.pone.0152372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/14/2016] [Indexed: 01/01/2023] Open
Abstract
Introduction Autonomic nervous system balance can be significantly deteriorated during heart failure exacerbation. However, it is still unknown whether these changes are only the consequence of heart failure decompensation or can also predict development thereof. Objectives were to verify if simple, non-invasive autonomic parameters, such as baroreflex sensitivity and short-term heart rate variability can provide independent of other well-known clinical parameters information on the risk of heart failure decompensation in patients with left ventricular systolic dysfunction. Methods In 142 stable patients with left ventricular ejection fraction ≤ 40%, baroreflex sensitivity and short-term heart rate variability, as well as other well-known clinical parameters, were analyzed. During 23 ± 9 months of follow-up 19 patients were hospitalized due to the heart failure decompensation (EVENT). Results Pre-specified cut-off values of baroreflex sensitivity (≤2.4 ms/mmHg) and low frequency power index of heart rate variability (≤19 ms2) were significantly associated with the EVENTs (hazard ratio 4.43, 95% confidence interval [CI] 1.35–14.54 and 5.41, 95% CI 1.87–15.65 respectively). EVENTs were also associated with other parameters, such as left ventricular ejection fraction, NYHA class, diuretic use, renal function, brain natriuretic peptide and hemoglobin level, left atrial size, left and right ventricular heart failure signs. After adjusting baroreflex sensitivity and low frequency power index for each of the abovementioned parameters, autonomic parameters were still significant predictors of hospitalization due to the heart failure decompensation. Conclusion Simple, noninvasive autonomic indices can be helpful in identifying individuals with increased risk of hospitalization due to the heart failure decompensation among clinically stable patients with left ventricular systolic dysfunction, even when adjusted for other well-known clinical parameters.
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Affiliation(s)
| | - Justyna Suchecka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Katarzyna Rozwadowska
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
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Mortara A, Vanoli E. Baroreceptor activation therapy: The importance of targeting the right patient: who needs to be treated? Eur J Heart Fail 2015; 17:1000-2. [PMID: 26417677 DOI: 10.1002/ejhf.328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Andrea Mortara
- Department of Cardiology, Heart failure Clinic, Policlinico di Monza, Via Amati 111, 20900, Monza MB, Italy
| | - Emilio Vanoli
- Cardiovascular Department, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.,Department of Molecular Medicine, University of Pavia, Italy
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Zile MR, Abraham WT, Weaver FA, Butter C, Ducharme A, Halbach M, Klug D, Lovett EG, Müller‐Ehmsen J, Schafer JE, Senni M, Swarup V, Wachter R, Little WC. Baroreflex activation therapy for the treatment of heart failure with a reduced ejection fraction: safety and efficacy in patients with and without cardiac resynchronization therapy. Eur J Heart Fail 2015; 17:1066-74. [DOI: 10.1002/ejhf.299] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 01/19/2023] Open
Affiliation(s)
- Michael R. Zile
- Division of Cardiology, Department of Medicine Medical University of South Carolina 114 Doughty Street, Thurmond/Gazes, 323, Charleston, SC 29425, USA and Ralph H. Johnson Department of Veterans Affairs Medical Center Charleston SC USA
| | - William T. Abraham
- Division of Cardiovascular Medicine The Ohio State University Columbus OH USA
| | - Fred A. Weaver
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Christian Butter
- Department of Cardiology Immanuel Heart Center Bernau—Medical School Brandenburg Bernau Germany
| | - Anique Ducharme
- Montreal Heart Institute University of Montréal Montreal Quebec Canada
| | - Marcel Halbach
- Department of Internal Medicine III University Hospital of Cologne Cologne Germany
| | - Didier Klug
- Department of Cardiology A University Hospital Lille France
| | | | | | | | - Michele Senni
- Cardiovascular Department Ospedale Papa Giovanni XXIII Bergamo Italy
| | - Vijay Swarup
- Department of Electrophysiology Arizona Heart Hospital Phoenix AZ USA
| | - Rolf Wachter
- Clinic for Cardiology and Pneumology University Medicine Göttingen and German Cardiovascular Research Center (DZHK) Göttingen Germany
| | - William C. Little
- Division of Cardiology University of Mississippi Medical Center Jackson MS USA
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PIERAGNOLI PAOLO, PEREGO GIOVANNIBATTISTA, RICCIARDI GIUSEPPE, SACCHI STEFANIA, PADELETTI MARGHERITA, MICHELUCCI ANTONIO, VALSECCHI SERGIO, PADELETTI LUIGI. Cardiac Resynchronization Therapy Acutely Improves Ventricular-Arterial Coupling by Reducing the Arterial Load: Assessment by Pressure-Volume Loops. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:431-7. [DOI: 10.1111/pace.12585] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/21/2014] [Accepted: 12/21/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | | | - LUIGI PADELETTI
- University of Florence; Florence Italy
- Gavazzeni Hospital; Bergamo Italy
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Patel HC, Rosen SD, Lindsay A, Hayward C, Lyon AR, di Mario C. Targeting the autonomic nervous system: Measuring autonomic function and novel devices for heart failure management. Int J Cardiol 2013; 170:107-17. [DOI: 10.1016/j.ijcard.2013.10.058] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 09/03/2013] [Accepted: 10/19/2013] [Indexed: 01/08/2023]
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Burggraaf JLI, Elffers TW, Segeth FM, Austie FMC, Plug MB, Gademan MGJ, Maan AC, Man S, de Muynck M, Soekkha T, Simonsz A, van der Wall EE, Schalij MJ, Swenne CA. Neurocardiological differences between musicians and control subjects. Neth Heart J 2013; 21:183-8. [PMID: 23283752 DOI: 10.1007/s12471-012-0372-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Exercise training is beneficial in health and disease. Part of the training effect materialises in the brainstem due to the exercise-associated somatosensory nerve traffic. Because active music making also involves somatosensory nerve traffic, we hypothesised that this will have training effects resembling those of physical exercise. METHODS We compared two groups of healthy, young subjects between 18 and 30 years: 25 music students (13/12 male/female, group M) and 28 controls (12/16 male/female, group C), peers, who were non-musicians. Measurement sessions to determine resting heart rate, resting blood pressure and baroreflex sensitivity (BRS) were held during morning hours. RESULTS Groups M and C did not differ significantly in age (21.4 ± 3.0 vs 21.2 ± 3.1 years), height (1.79 ± 0.11 vs 1.77 ± 0.10 m), weight (68.0 ± 9.1 vs 66.8 ± 10.4 kg), body mass index (21.2 ± 2.5 vs 21.3 ± 2.4 kg∙m(-2)) and physical exercise volume (39.3 ± 38.8 vs 36.6 ± 23.6 metabolic equivalent hours/week). Group M practised music daily for 1.8 ± 0.7 h. In group M heart rate (65.1 ± 10.6 vs 68.8 ± 8.3 beats/min, trend P =0.08), systolic blood pressure (114.2 ± 8.7 vs 120.3 ± 10.0 mmHg, P = 0.01), diastolic blood pressure (65.0 ± 6.1 vs 71.0 ± 6.2 mmHg, P < 0.01) and mean blood pressure (83.7 ± 6.4 vs 89.4 ± 7.1, P < 0.01) were lower than in group C. BRS in groups M and C was 12.9 ± 6.7 and 11.3 ± 5.8 ms/mmHg, respectively (P = 0.17). CONCLUSIONS The results of our study suggest that active music making has training effects resembling those of physical exercise training. Our study opens a new perspective, in which active music making, additionally to being an artistic activity, renders concrete health benefits for the musician.
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Affiliation(s)
- J L I Burggraaf
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, the Netherlands
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Abstract
Heart rate variability (HRV) non-invasively assesses the activity of the autonomic nervous system. During the past 30 years, an increasing number of studies have related the imbalance of the autonomic nervous system (as assessed by HRV) to several pathophysiogical conditions, particularly in the setting of cardiovascular disease. Sudden death, coronary artery disease, heart failure, or merely cardiovascular risk factors (smoking, diabetes, hyperlipidemia, and hypertension) are the best-known clinical circumstances that can affect and/or be affected by the autonomic nervous system. Analyses of HRV variables have been proposed as a component of the clinical evaluation for patient risk stratification due to its independent prognostic information. Yet the potential for HRV to be used widely in clinical practice remains to be established.
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Affiliation(s)
- Borejda Xhyheri
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale. University of Bologna, Bologna, Italy
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Abstract
The arterial baroreflex is an important determinant of the neural regulation of the cardiovascular system. It has been recognised that baroreflex-mediated sympathoexcitation contributes to the development and progression of many cardiovascular disorders. Accordingly, the quantitative estimation of the arterial baroreceptor-heart rate reflex (baroreflex sensitivity, BRS), has been regarded as a synthetic index of neural regulation at the sinus atrial node. The evaluation of BRS has been shown to provide clinical and prognostic information in a variety of cardiovascular diseases, including myocardial infarction and heart failure that are reviewed in the present article.
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Merkely B, Roka A. Assessment of heart rate recovery after exercise stress test: implications for cardiac resynchronization therapy. Europace 2011; 13:458-9. [PMID: 21208946 DOI: 10.1093/europace/euq452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Response. Pacing Clin Electrophysiol 2009. [DOI: 10.1111/j.1540-8159.2009.02420_4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gademan MGJ, van Bommel RJ, Borleffs CJW, Man S, Haest JCW, Schalij MJ, van der Wall EE, Bax JJ, Swenne CA. Biventricular pacing-induced acute response in baroreflex sensitivity has predictive value for midterm response to cardiac resynchronization therapy. Am J Physiol Heart Circ Physiol 2009; 297:H233-7. [DOI: 10.1152/ajpheart.00113.2009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In a previous study we demonstrated that the institution of biventricular pacing in chronic heart failure (CHF) acutely facilitates the arterial baroreflex. The arterial baroreflex has important prognostic value in CHF. We hypothesized that the acute response in baroreflex sensitivity (BRS) after the institution of cardiac resynchronization therapy (CRT) has predictive value for midterm response. One day after implantation of a CRT device in 33 CHF patients (27 male/6 female; age, 66.5 ± 9.5 yr; left ventricular ejection fraction, 28 ± 7%) we measured noninvasive BRS and heart rate variability (HRV) in two conditions: CRT device switched on and switched off (on/off order randomized). Echocardiography was performed before implantation (baseline) and 6 mo after implantation (follow-up). CRT responders were defined as patients in whom left ventricular end-systolic volume at follow-up had decreased by ≥15%. Responders (69.7%) and nonresponders (30.3%) had similar baseline characteristics. In responders, CRT increased BRS by 30% ( P = 0.03); this differed significantly ( P = 0.02) from the average BRS change (−2%) in the nonresponders. CRT also increased HRV by 30% in responders ( P = 0.02), but there was no significant difference found compared with the increase in HRV (8%) in the nonresponders. Receiver-operating characteristic curve analysis revealed that the percent BRS increase had predictive value for the discrimination of responders and nonresponders (area under the curve, 0.69; 95% confidence interval, 0.51–0.87; maximal accuracy, 0.70). Our study demonstrates that a CRT-induced acute BRS increase has predictive value for the echocardiographic response to CRT. This finding suggests that the autonomic nervous system is actively involved in CRT-related reverse remodeling.
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To the Editor:. Pacing Clin Electrophysiol 2009; 32:964; author reply 964-5. [DOI: 10.1111/j.1540-8159.2009.02420_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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