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Nishimura YK, Komatsu J, Sugane H, Hosoda H, Imai RI, Nakaoka Y, Nishida K, Seki SI, Kubo T, Kitaoka H, Kubokawa SI, Kawai K, Hamashige N, Doi Y. Takotsubo Syndrome in Older Men - Clinical Characteristics Differ by Sex and Age. Circ Rep 2024; 6:201-208. [PMID: 38860182 PMCID: PMC11162854 DOI: 10.1253/circrep.cr-23-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/21/2024] [Accepted: 05/05/2024] [Indexed: 06/12/2024] Open
Abstract
Background: Takotsubo syndrome (TTS) in male patients is under-studied, particularly in the older population. Methods and Results: From 226 patients with TTS, 44 older male patients (prevalence rate: 19.5%, age: median 77 years) were compared with 182 older female patients (prevalence rate: 80.5%, age: median 80 years). Emotional triggers of TTS were less frequent (2% vs. 19%; P=0.007), whereas physical triggers were more frequent (75% vs. 58%; P=0.040) in older men than in women. Among physical triggers, serious respiratory infection was more common in older men than in women. As initial clues to the diagnosis, ECG T-wave inversion was more frequent (48% vs. 29%; P=0.018) and chest pain and/or dyspnea were less common (23% vs. 38%; P=0.050) in older men than in women. In total, 14 patients (6%) had cardiogenic shock and 41 (18%) had severe heart failure as complications, although there were no significant differences in the frequency of these complications between older men and women. Although cardiac death occurred in 3 female patients (1%) and noncardiac death in 3 male and 5 female patients (4%), there were no significant differences in death rate between older men and women. Conclusions: Emotional triggers of TTS were extremely infrequent whereas physical triggers were common in older men. Although severe heart failure was common, there were no significant differences in the frequency of complications and in-hospital deaths between older men and women.
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Affiliation(s)
| | - Junya Komatsu
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Hiroki Sugane
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Hayato Hosoda
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | | | - Yoko Nakaoka
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Koji Nishida
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Shu-Ichi Seki
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Toru Kubo
- Department of Cardiology and Aging Science, Kochi Medial School Kochi Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Aging Science, Kochi Medial School Kochi Japan
| | | | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | | | - Yoshinori Doi
- Department of Cardiology, Chikamori Hospital Kochi Japan
- Cardiomyopathy Institute, Chikamori Hospital Kochi Japan
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2
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Mehta PK, Huang J, Levit RD, Malas W, Waheed N, Bairey Merz CN. Ischemia and no obstructive coronary arteries (INOCA): A narrative review. Atherosclerosis 2022; 363:8-21. [PMID: 36423427 PMCID: PMC9840845 DOI: 10.1016/j.atherosclerosis.2022.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/30/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
Myocardial ischemia with no obstructive coronary arteries (INOCA) is a chronic coronary syndrome condition that is increasingly being recognized as a substantial contributor to adverse cardiovascular mortality and outcomes, including myocardial infarction and heart failure with preserved ejection fraction (HFpEF). While INOCA occurs in both women and men, women are more likely to have the finding of INOCA and are more adversely impacted by angina, with recurrent hospitalizations and a lower quality of life with this condition. Abnormal epicardial coronary vascular function and coronary microvascular dysfunction (CMD) have been identified in a majority of INOCA patients on invasive coronary function testing. CMD can co-exist with obstructive epicardial coronary artery disease (CAD), diffuse non-obstructive epicardial CAD, and with coronary vasospasm. Epicardial vasospasm can also occur with normal coronary arteries that have no atherosclerotic plaque on intravascular imaging. While all predisposing factors are not clearly understood, cardiometabolic risk factors, and endothelium dependent and independent mechanisms that increase oxidative stress and inflammation are associated with microvascular injury, CMD and INOCA. Cardiac autonomic dysfunction has also been implicated in abnormal vasoreactivity and persistent symptoms. INOCA is under-recognized and under-diagnosed, partly due to the heterogenous patient populations and mechanisms. However, diagnostic testing methods are available to guide INOCA management. Treatment of INOCA is evolving, and focuses on cardiac risk factor control, improving ischemia, reducing atherosclerosis progression, and improving angina and quality of life. This review focuses on INOCA, relations to HFpEF, available diagnostics, current and investigational therapeutic strategies, and knowledge gaps in this condition.
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Affiliation(s)
- Puja K Mehta
- Emory Women's Heart Center and Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Jingwen Huang
- J. Willis Hurst Internal Medicine Residency Training Program, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca D Levit
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Waddah Malas
- Cardiovascular Disease Fellowship Training Program, Loyola Medical Center, Chicago, IL, USA
| | - Nida Waheed
- Cardiovascular Disease Fellowship Training Program, Emory University School of Medicine, Atlanta, GA, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
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3
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Wittstein IS. Why Sex Matters in Takotsubo Syndrome. J Am Coll Cardiol 2022; 79:2094-2096. [PMID: 35618346 DOI: 10.1016/j.jacc.2022.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ilan S Wittstein
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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4
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Salin S, Savukoski S, Tulppo M, Pesonen P, Auvinen J, Suvanto E, Puukka K, Niinimäki M. Does climacteric status impact regulation of the autonomic nervous system at the age of 46 years? Climacteric 2022; 25:586-594. [PMID: 35383514 DOI: 10.1080/13697137.2022.2052842] [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: 11/03/2022]
Abstract
OBJECTIVE To investigate whether an earlier-onset climacteric phase is associated with autonomic imbalance at the age of 46 years. METHODS This cross-sectional birth cohort study included 2661 women aged 46 years. Participants were divided into climacteric (n = 359) and preclimacteric (n = 2302) groups based on menstrual history and follicle stimulating hormone values. The mean heart rate (HR), low-frequency (LF) power, high-frequency (HF) power and LF/HF ratio were analyzed from heart rate variability recordings. The variables were compared between the groups using multivariable linear regression models, including body mass index, smoking and physical activity. The effects of hormone therapy and hot flashes on autonomic function were evaluated in sub-analyses. RESULTS Climacteric women had a lower mean HR in seated (71.9 ± 10.5 vs. 72.6 ± 10.4 bpm, p = 0.015) and standing (81.2 ± 12.8 vs. 83.6 ± 12.1 bpm, p = 0.002) positions compared to preclimacteric women, and the differences remained significant after the adjustments. In the sub-analyses, more frequent hot flashes were associated with a lower LF power and LF/HF ratio in the sitting position. CONCLUSIONS The present study suggested an association between greater parasympathetic activation in women with more advanced climacteric status at the age of 46 years.
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Affiliation(s)
- S Salin
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Oulu University Hospital and University of Oulu, OYS, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - S Savukoski
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Oulu University Hospital and University of Oulu, OYS, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M Tulppo
- Research Unit of Biomedicine, Medical Research Center, Faculty of Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - P Pesonen
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - J Auvinen
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Centre for Life Course Health Research, University of Oulu, Oulu, Finland
| | - E Suvanto
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Oulu University Hospital and University of Oulu, OYS, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - K Puukka
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,NordLab Oulu, Oulu University Hospital, Oulu, Finland.,Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - M Niinimäki
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Oulu University Hospital and University of Oulu, OYS, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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5
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Huhta TA, Ran L, Cooper CW, Davis MJ, Kornbluth J, Salem DN. An Association of Takotsubo Cardiomyopathy with Guillain-Barré Syndrome. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2022. [DOI: 10.2147/rrcc.s336664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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6
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Zhu X, Chu H, Li J, Wang C, Li W, Wang Z, Xu Z, Jing Y, Zhao R, Zhong L, Hu N. New Discovery of Left Atrial Macroreentry Tachycardia: Originating from the Spontaneous Scarring of Left Atrial Anterior Wall. J Interv Cardiol 2021; 2021:2829070. [PMID: 34992506 PMCID: PMC8694995 DOI: 10.1155/2021/2829070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/17/2021] [Indexed: 11/18/2022] Open
Abstract
AIMS This study sought to describe left atrial macroreentry tachycardia (LAMRT) originating from the spontaneous scarring of left atrial anterior wall (LAAW) and its clinical and electrophysiological characteristics, mechanisms, and the formation of substrates. METHODS AND RESULTS 9 of 123 patients (89% female, age 79.78 ± 5.59 years) had LAMRT originating from the LAAW with no cardiac surgery or prior left atrial (LA) ablation. The mean tachycardia cycle length (TCL) was 241.67 ± 38.00 milliseconds. Spontaneous scars areas and low voltage areas (LVAs) in the LAAW were found in all patients. Successful ablation of the critical isthmus caused termination of the LAMRT and was not inducible in all patients. Arrhythmogenic substrates of LAMRT were the spontaneous scars of LAAW, which matched with the aorta or/and pulmonary artery contact area. The area under the curve (AUC) of age and combination of gender and age for predicting the LAMRT originating from the LAAW were 0.918 and 0.951, respectively, with a cutoff value of ≥73.5 years of age and gender (female) predicting LAMRT with 88.9% sensitivity and 89% specificity. CONCLUSION Combination of gender and age provides a simple and useful criterion to distinguish LAMRT from cavotricuspid isthmus- (CTI-) dependent atrial tachycardia in macroreentry atrial tachycardia (MRAT) in patients without a history of surgery or ablation. Aorta or/and pulmonary artery contacting LA may be related to spontaneous scars. Ablation the isthmus eliminated LAMRT in all patients.
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Affiliation(s)
- Xuefeng Zhu
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Hongxia Chu
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Jianping Li
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Chunxiao Wang
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Wenjing Li
- Doppler Ultrasonic Department, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Zhen Wang
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Zhiyuan Xu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yanyan Jing
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Ruifu Zhao
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Lin Zhong
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China
| | - Naibao Hu
- Department of Statistics, Binzhou Medical University, Yantai, China
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7
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Souza HCD, Philbois SV, Veiga AC, Aguilar BA. Heart Rate Variability and Cardiovascular Fitness: What We Know so Far. Vasc Health Risk Manag 2021; 17:701-711. [PMID: 34803382 PMCID: PMC8598208 DOI: 10.2147/vhrm.s279322] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/05/2021] [Indexed: 12/15/2022] Open
Abstract
Fluctuation analysis in intervals between heartbeats provides important indices related to autonomic modulation of heart rate variability (HRV). These indices are considered predictors of morbidity and mortality as they are frequently altered in patients with chronic degenerative diseases, especially in those with cardiovascular and metabolic diseases. Similarly, a reduction in HRV is common with aging. In all cases, cardiovascular fitness is often reduced to below the predicted values. In turn, increases in cardiovascular fitness through regular physical exercise, especially aerobic exercise, represent an important therapeutic tool capable of promoting positive adjustments in cardiac autonomic modulation. These adjustments are characterized by reduced sympathetic modulatory influence and/or increased vagal modulatory influence on the heart, increasing the HRV. Therefore, several methodological tools have been used to assess the degree of impairment of autonomic modulation and the therapeutic effects of physical exercise. In contrast, establishment of strict protocols in experimental design is a main challenge in establishing HRV analysis as a robust parameter for evaluating cardiovascular homeostasis. Thus, this review aimed to contribute to the understanding of autonomic modulation of HRV and its relationship with cardiovascular fitness, highlighting the advances made thus far, the applicability of analysis tools, and the confounding factors observed frequently.
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Affiliation(s)
- Hugo Celso Dutra Souza
- Department of Health Science, Ribeirão Preto Medical School of University of São Paulo, São Paulo, Brazil
| | - Stella Vieira Philbois
- Department of Health Science, Ribeirão Preto Medical School of University of São Paulo, São Paulo, Brazil
| | - Ana Catarine Veiga
- Department of Health Science, Ribeirão Preto Medical School of University of São Paulo, São Paulo, Brazil
| | - Bruno Augusto Aguilar
- Department of Health Science, Ribeirão Preto Medical School of University of São Paulo, São Paulo, Brazil
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8
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Cardiovascular autonomic nervous system function and hip fracture risk: the Cardiovascular Health Study. Arch Osteoporos 2021; 16:163. [PMID: 34719754 PMCID: PMC9059792 DOI: 10.1007/s11657-021-01028-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/18/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Among 1299 older adults with 24-h Holter monitoring data at baseline, followed for approximately 15 years, 190 incident hip fractures occurred. Increased heart rate variability was independently associated with reduced risk of hip fracture among female participants. PURPOSE Autonomic nervous system function modulates bone remodeling in rodent osteoporosis models. We tested whether cardiovascular autonomic function is associated with hip fracture risk in humans. METHODS Participants were 1299 subjects from the Cardiovascular Health Study (mean age 72.8 years). Eight heart rate variability (HRV) measures (time and frequency domains, detrended fluctuation analysis variables, and heart rate turbulence) were derived from 24-h Holter monitor scans in sinus rhythm. Median follow-up for incident hip fracture was 14.7 years [IQR 9.1, 20.2]. Cox proportional hazards models were used to calculate hazard ratios (95% confidence intervals, CI). RESULTS There were 144 hip fractures among 714 women (1.31 [1.06, 1.61] per 100-person years) and 46 among 585 men (0.62 [0.43, 0.90] per 100 person-years). From among HRV variables examined, a one standard deviation (SD) higher variation between normal heart beats over 24 h (the SD of NN intervals [SDNN]) was associated with a multivariable-adjusted lower hip fracture risk (HR [Formula: see text] 0.80; 95% CI 0.65-0.99; p = 0.04) in women. The adjusted association between very low frequency power, and hip fracture was borderline statistically significant in women (HR [Formula: see text] 0.82; 95% CI, 0.66-1.00; p = 0.06). When the 8 HRV variables were considered conjointly and adjusted for each other's association with hip fracture risk, a 1 SD higher SDNN value was significantly associated with reduced hip fracture risk in women (HR 0.74; 95% CI, 0.50-0.99; p = 0.05). No HRV variables were associated with hip fracture in men. CONCLUSIONS In older women, increased heart rate variation is associated with hip fracture risk.
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9
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Dorogovtsev VN, Yankevich DS, Goswami N. Effects of an Innovative Head-Up Tilt Protocol on Blood Pressure and Arterial Stiffness Changes. J Clin Med 2021; 10:1198. [PMID: 33805654 PMCID: PMC7998828 DOI: 10.3390/jcm10061198] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/26/2021] [Accepted: 03/09/2021] [Indexed: 11/16/2022] Open
Abstract
The objective of our study was to identify blood pressure (BP) and pulse wave velocity (PWV) changes during orthostatic loading, using a new the head-up tilt test (HUTT), which incorporates the usage of a standardized hydrostatic column height. METHODS 40 healthy subjects 20-32 years performed HUTT, which was standardized to a height of the hydrostatic column at 133 cm. Exposure time was 10 min in each of 3 positions: horizontal supine 1, HUTT, and horizontal supine 2. The individual tilt up angle made it possible to set the standard value of the hydrostatic column. Hemodynamic parameters were recorded beat to beat using "Task Force Monitor 3040 i", pulse-wave velocity (PWV) was measured with a sphygmograph-sphygmomanometer VaSera VS1500N. RESULTS Orthostatic loading caused a significant increase in heart rate (HR) and a decrease in stroke volume (SV) (p < 0.05) but no significant reductions in cardiac output, changes in total vascular resistance (TVR), or BP. An analysis of personalized data on systolic blood pressure (SBP) changes in tilt up position as compared to horizontal position (ΔSBP) revealed non-significant changes in this index in 48% of subjects (orthostatic normotension group), in 32% there was a significant decrease in it (orthostatic hypotension group) and in 20% there was a significant increase in it (orthostatic hypertension group). These orthostatic changes were not accompanied by any clinical symptoms and/or syncope. During HUTT, all subjects had in the PWV a significant increase of approximately 27% (p < 0.001). CONCLUSION The new test protocol involving HUTT standardized to a height of hydrostatic column at 133 cm causes typical hemodynamics responses during orthostatic loading. Individual analysis of the subjects revealed subclinical orthostatic disorders (OSD) in up to 52% of the test persons. During HUTT, all test subjects showed a significant increase in PWV. The new innovative HUTT protocol can be applied in multi-center studies in healthy subjects to detect preclinical forms of orthostatic disorders under standard gravity load conditions.
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Affiliation(s)
- Victor N. Dorogovtsev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (V.N.D.); (D.S.Y.)
| | - Dmitry S. Yankevich
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (V.N.D.); (D.S.Y.)
| | - Nandu Goswami
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, 3810 Graz, Austria
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10
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Borodzicz S, Czarzasta K, Opolski G, Cudnoch-Jędrzejewska A. Autonomic nervous system in Takotsubo syndrome. Heart Fail Rev 2020; 24:101-108. [PMID: 30058016 DOI: 10.1007/s10741-018-9729-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Takotsubo syndrome (TTS) is an acute and usually reversible heart failure syndrome with symptoms resembling acute myocardial infarction, however, without obstruction of coronary arteries. In the majority of cases, TTS is preceded by emotional or physical stress and the disease concerns mainly postmenopausal women. Although several hypotheses have been introduced, the pathogenesis of TTS is controversial and still remains to be determined. As reported in recent studies, the role of the autonomic nervous system (ANS) seems to be pivotal in the pathogenesis of TTS. Therefore, the aim of this article is to summarize and discuss the current knowledge of the pathogenesis of TTS with a special focus on the ANS.
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Affiliation(s)
- Sonia Borodzicz
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, 1b Banacha Street, 02-097, Warsaw, Poland.,1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Czarzasta
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, 1b Banacha Street, 02-097, Warsaw, Poland
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Cudnoch-Jędrzejewska
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, 1b Banacha Street, 02-097, Warsaw, Poland.
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11
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Wittstein IS. Why Age Matters in Takotsubo Syndrome. J Am Coll Cardiol 2020; 75:1878-1881. [PMID: 32327097 DOI: 10.1016/j.jacc.2020.03.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/18/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Ilan S Wittstein
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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12
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Comparison of Linear and Nonlinear HRV Dynamics Across Exercise Intensities After Menopause. J Aging Phys Act 2020; 28:149-154. [PMID: 31629356 DOI: 10.1123/japa.2018-0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 06/08/2019] [Accepted: 06/10/2019] [Indexed: 11/18/2022]
Abstract
The authors compared the linear and nonlinear heart rate variability dynamics from rest through maximal exercise in postmenopausal women who trained at either moderate or high intensities. The outcome variables included the RR triangular index, TINN, SD1, SD2, SD1/SD2, DFA α1, DFA α2, and α1/α2. Maximal exercise reduced SD1, SD2, DFA α1, DFA α2, α1/α2, RRTri, and TINN in both groups and increased SD1/SD2 (p < .05). Two minutes of active recovery produced significant increases in SD1, SD2, DFA α1, and TINN, compared with exercise in both groups (p < .0001). There was also a significant main effect between groups for RRTri during exercise recovery, with the moderate group achieving higher levels (p < .04). The authors have shown that both moderate and vigorous exercise training can lead to a healthy response to maximal exercise and recovery, with the moderate group having a slightly improved recovery in the triangular index.
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13
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Stępniewska A, Budnik M, Krzemiński K, Niewiadomski W, Gąsiorowska A, Opolski G, Kochanowski J, Mieczkowska K, Żukowska K, Szepietowska K, Kowalik R. Impaired hemodynamic response to tilt, handgrip and Valsalva manoeuvre in patients with takotsubo syndrome. Auton Neurosci 2019; 220:102555. [PMID: 31331695 DOI: 10.1016/j.autneu.2019.102555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/12/2019] [Accepted: 06/01/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Long-term β-adrenolytics treatment in takotsubo syndrome (TTS) patients is based on the premise, that TTS is strongly associated with sympathetic nervous system overactivity. The aim of the study was to establish hemodynamic response to tilt, handgrip and Valsalva manoeuvre in patients with takotsubo syndrome compared to healthy subjects (CONTROL) and patients after ST Elevation Myocardial Infarction (STEMI). MATERIAL AND METHOD Echocardiographic examination was performed at rest, ECG and continuously non-invasively measured arterial blood pressure were used for evaluation of hemodynamic responses to Valsalva manoeuvre, static handgrip (HG) followed by post-exercise ischemia, and tilt. Ten healthy women, 20 with TTS and 20 after STEMI, mean age 64 ± 8.5 years, participated in the study. RESULTS Pressor response to Valsalva manoeuvre and tilt in TTS group was diminished in comparison to CONTROL and close to that of STEMI. During HG, increase of SBP was the lowest in TTS group. Data indirectly suggest that it was due to deficient stroke volume in TTS and STEMI patients during these manoeuvres; though echocardiographic findings at rest did not reveal any significant differences between groups. CONCLUSIONS Our data show that despite apparent resolution of the immediate effects of TTS, impaired response to cardiovascular challenge, similar to that in STEMI patients, persisted. As the manoeuvres applied mimic daily life situations, causes of impairment should be searched for and potential health risk evaluated.
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Affiliation(s)
- Anna Stępniewska
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Monika Budnik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland.
| | - Krzysztof Krzemiński
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland; 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Wiktor Niewiadomski
- 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
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Janusz Kochanowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | | | - Katarzyna Żukowska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | | | - Robert Kowalik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
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Sachse C, Trozic I, Brix B, Roessler A, Goswami N. Sex differences in cardiovascular responses to orthostatic challenge in healthy older persons: A pilot study. Physiol Int 2019; 106:236-249. [DOI: 10.1556/2060.106.2019.16] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background
Premenopausal women show a higher incidence of orthostatic hypotension than age-matched men, but there are limited data available on sex differences in cardiovascular responses to orthostatic challenge in healthy older persons. We investigated sex differences in hemodynamic and autonomic responses to orthostatic challenge in healthy older males and females.
Materials and methods
Fourteen older healthy women and 10 age-matched men performed a sit-to-stand test (5 min of sitting followed by 5 min of standing). A Task Force® Monitor continuously measured the following beat-to-beat hemodynamic parameters: heart rate, systolic blood pressure, diastolic blood pressure, mean blood pressure, stroke index, cardiac index, and total peripheral resistance index. Cardiac autonomic activity, low-frequency (LF: 0.04–0.15 Hz) normalized (LFnuRRI) and high-frequency (HF: 0.15–0.4 Hz) normalized (HFnuRRI) components, and the ratio between LF and HF power (LF/HF) were calculated using power spectral analysis of heart rate variability.
Results
Across all hemodynamic parameters, there were no significant differences between the sexes at baseline and during standing. LFnuRRI (median: 70.2 vs. 52.3, p < 0.05) and LF/HF ratio (median: 2.4 vs. 1.1, p < 0.05) were significantly higher, whereas HFnuRRI (median: 29.8 vs. 47.7, p < 0.05) was lower among women at baseline. All other heart rate variability measures did not differ between the sexes.
Conclusions
The data indicate that older women showed higher sympathetic and lower parasympathetic activity at rest compared to age-matched men. These results are contradictory to the observations from previous studies, which showed a reduced sympathetic and enhanced parasympathetic activity in women in all ages. Further studies are required to determine the underlying mechanisms contributing to higher incidence of orthostatic hypotension in older females.
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Affiliation(s)
- C Sachse
- 1 Gravitational Physiology and Medicine Research Unit, Physiology Division, Otto Loewi Center of Research in Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria
| | - I Trozic
- 1 Gravitational Physiology and Medicine Research Unit, Physiology Division, Otto Loewi Center of Research in Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria
| | - B Brix
- 1 Gravitational Physiology and Medicine Research Unit, Physiology Division, Otto Loewi Center of Research in Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria
| | - A Roessler
- 1 Gravitational Physiology and Medicine Research Unit, Physiology Division, Otto Loewi Center of Research in Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria
| | - N Goswami
- 1 Gravitational Physiology and Medicine Research Unit, Physiology Division, Otto Loewi Center of Research in Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria
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15
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Abstract
It is from the discovery of leptin and the central nervous system as a regulator of bone remodeling that the presence of autonomic nerves within the skeleton transitioned from a mere histological observation to the mechanism whereby neurons of the central nervous system communicate with cells of the bone microenvironment and regulate bone homeostasis. This shift in paradigm sparked new preclinical and clinical investigations aimed at defining the contribution of sympathetic, parasympathetic, and sensory nerves to the process of bone development, bone mass accrual, bone remodeling, and cancer metastasis. The aim of this article is to review the data that led to the current understanding of the interactions between the autonomic and skeletal systems and to present a critical appraisal of the literature, bringing forth a schema that can put into physiological and clinical context the main genetic and pharmacological observations pointing to the existence of an autonomic control of skeletal homeostasis. The different types of nerves found in the skeleton, their functional interactions with bone cells, their impact on bone development, bone mass accrual and remodeling, and the possible clinical or pathophysiological relevance of these findings are discussed.
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Affiliation(s)
- Florent Elefteriou
- Department of Molecular and Human Genetics and Orthopedic Surgery, Center for Skeletal Medicine and Biology, Baylor College of Medicine , Houston, Texas
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16
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Odening KE, Deiß S, Dilling-Boer D, Didenko M, Eriksson U, Nedios S, Ng FS, Roca Luque I, Sanchez Borque P, Vernooy K, Wijnmaalen AP, Yorgun H. Mechanisms of sex differences in atrial fibrillation: role of hormones and differences in electrophysiology, structure, function, and remodelling. Europace 2018; 21:366-376. [DOI: 10.1093/europace/euy215] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/03/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Katja E Odening
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Hugstetter Str. 55, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, HX Maastricht, The Netherlands
| | - Sebastian Deiß
- Asklepios Medical Center Altona, Department of Cardiology, Arrhythmia Unit, Hamburg, Germany
| | | | - Maxim Didenko
- Department of Surgical and Interventional Arrhythmology, Kuprianov's Cardiovascular Surgery Clinic, Military Medical Academy, St. Petersburg, Russia
| | - Urs Eriksson
- Rhythmology Division, Department of Medicine, GZO Regional Health Center, Wetzikon, Switzerland
- Cardioimmunology, Center for Molecular Cardiology, University of Zurich, Zurich-Schlieren, Switzerland
| | - Sotirios Nedios
- Heart Center, University of Leipzig, Leipzig, Germany
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Fu Siong Ng
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Ivo Roca Luque
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, HX Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, GA Nijmegen, The Netherlands
| | - Adrianus P Wijnmaalen
- Department of Cardiology, Leiden University Medical Center, ZA Leiden, The Netherlands
| | - Hikmet Yorgun
- Department of Cardiology, Electrophysiology Unit, Hacettepe University, Ankara, Turkey
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17
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Koifman R, Dayan L, Ablin JN, Jacob G. Cardiovascular Autonomic Profile in Women With Premenstrual Syndrome. Front Physiol 2018; 9:1384. [PMID: 30327616 PMCID: PMC6174485 DOI: 10.3389/fphys.2018.01384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/11/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction: The premenstrual syndrome (PMS) is a constellation of somatic and psychogenic symptoms that appear during late luteal (LL) phase of the menstrual cycle. Since many symptoms could be related to the autonomic nervous system, we hypothesized that the sympathetic nervous system is perturbed in PMS. Methods: The cardiovascular autonomic profile of nine women with PMS (30.4 ± 2.5 years) were compared to that of nine healthy controls (30 ± 2.5 years) during their early follicular (EF) and LL phases of the menstrual cycle. Plasma norepinephrine (NE) concentrations, power spectral analysis of heart rate and systolic blood pressure (BP), and baroreflex sensitivity (BRS) were assessed during recumbency and a head-up tilt (HUT). Cardiovascular responsiveness to α1- and β-adrenoreceptor agonists (phenylephrine and isoproterenol, respectively) were also assessed. Results: In the LL phase, the plasma NE concentrations in women with PMS during recumbency and a HUT were lower than those in women without PMS [180 ± 30 vs. 320 ± 50 pg/ml; p = 0.04 (recumbent), and 480 ± 70 vs. 940 ± 180 pg/ml: p = 0.02 (HUT)]. In the LL phase, the dose of phenylephrine required to increase systolic BP by 15 mmHg in women with PMS was significantly greater than that in women without PMS (202 ± 30 μg vs. 138 ± 20 μg; p = 0.02). Sympathetic and vagal cardiac control indices were comparable in the two groups in the menstrual phases. In women with PMS, the value of LFSBP in the LL phase was lower than that in the EF phase (0.98 ± 0.2 vs. 1.77 ± 0.4 mmHg2, p = 0.04). The increase in LFSBP in women with PMS in the LL phase during HUT was greater than that in the controls, 5.2 ± 0.9 vs. 3.1 ± 0.5 mmHg2, p = 0.045, and this increase was associated with a significant decrease in BRS. Conclusion: In women with PMS without psychogenic symptoms, the sympathetic control of their circulation is not dominant during the LL phase of their menstrual cycle.
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Affiliation(s)
- Rimma Koifman
- Department of Internal Medicine F, J. Recanati Autonomic Dysfunction Center, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Dayan
- Department of Internal Medicine F, J. Recanati Autonomic Dysfunction Center, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob N Ablin
- Department of Internal Medicine F, J. Recanati Autonomic Dysfunction Center, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giris Jacob
- Department of Internal Medicine F, J. Recanati Autonomic Dysfunction Center, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Perioperative Stress-Induced (Takotsubo) Cardiomyopathy in Liver Transplant Recipients. ACTA ACUST UNITED AC 2018; 4:56-63. [PMID: 30581996 PMCID: PMC6294992 DOI: 10.2478/jccm-2018-0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/19/2018] [Indexed: 12/13/2022]
Abstract
A comprehensive analysis of published cases of Takotsubo cardiomyopathy, occurred in liver transplant recipients in the perioperative period, has been attempted in this review. Predisposing factors, precipitating events, potential physiological mechanisms, acute and post-event management have been discussed.
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19
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Orri JC, Hughes EM, Mistry DG, Scala AH. Is Vigorous Exercise Training Superior to Moderate for CVD Risk after Menopause? Sports Med Int Open 2017; 1:E166-E171. [PMID: 30539103 PMCID: PMC6226081 DOI: 10.1055/s-0043-118094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/10/2017] [Accepted: 07/21/2017] [Indexed: 01/24/2023] Open
Abstract
Postmenopausal women have an increased risk for cardiovascular disease through many factors, such as a sedentary lifestyle and reduced heart rate variability (HRV). Endurance training improves coronary risk but the role of exercise intensity is unclear. The purpose of this observational study was to evaluate the effects of moderate versus vigorous exercise on cardiovascular disease risk in postmenopausal women. Thirty-six postmenopausal women who self-reported training at moderate (3-5.9 METS; n=18; age 58.9±4.4yr) or vigorous intensities (>6 METS; n=18; age 59.7±5.2yr) participated. C-reactive protein (CRP), HRV, VO 2 max, and stress (Perceived Stress Survey, Menopause Rating Scale) were measured. Groups were compared using independent samples t- tests, and associations of exercise intensities with CRP and HRV were assessed using multiple regression. CRP, HRV, and VO 2 max were similar ( p >0.05). Vigorous exercise had lower stress subscale scores ( p <0.01) and higher counter-stress subscale scores compared to moderate ( p <0.05). There was a positive association between time spent in vigorous exercise and HRV ( p <0.05).Vigorous exercise may not confer additional benefits in CRP and HRV over moderate, except for stress reduction. However, more time spent in vigorous exercise was associated with higher HRV. Therefore, increased parasympathetic tone may provide cardioprotection after menopause.
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Affiliation(s)
| | | | - Deepa G Mistry
- Kinesiology, University of San Francisco, San Francisco, United States
| | - Antone H Scala
- Kinesiology, University of San Francisco, San Francisco, United States
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20
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Effect of age and gender on the QTc-interval in healthy individuals and patients with long-QT syndrome. Trends Cardiovasc Med 2017; 28:64-75. [PMID: 28869094 DOI: 10.1016/j.tcm.2017.07.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/15/2022]
Abstract
Age- and gender-related differences in QTc-interval are most likely the result of changes in sex-specific hormones. Although the exact mechanisms and pathophysiology of sex hormones on the QTc-interval are not known, testosterone appears to shorten the QTc-interval. In females, however, there is a more complex interaction between progesterone and estrogen. In patients with an impaired repolarization, such as long-QT syndrome (LQTS), the effect of these sex hormones on the QTc-interval is more pronounced with a differing sensitivity between the LQTS genotypes.
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21
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Li Y, Zhao Z, Cai J, Gu B, Lv Y, Zhao L. The Frequency-Dependent Aerobic Exercise Effects of Hypothalamic GABAergic Expression and Cardiovascular Functions in Aged Rats. Front Aging Neurosci 2017; 9:212. [PMID: 28713263 PMCID: PMC5491914 DOI: 10.3389/fnagi.2017.00212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/16/2017] [Indexed: 01/11/2023] Open
Abstract
A decline in cardiovascular modulation is a feature of the normal aging process and associated with cardiovascular diseases (CVDs) such as hypertension and stroke. Exercise training is known to promote cardiovascular adaptation in young animals and positive effects on motor and cognitive capabilities, as well as on brain plasticity for all ages in mice. Here, we examine the question of whether aerobic exercise interventions may impact the GABAergic neurons of the paraventricular nucleus (PVN) in aged rats which have been observed to have a decline in cardiovascular integration function. In the present study, young (2 months) and old (24 months) male Wistar rats were divided into young control (YC), old sedentary, old low frequency exercise (20 m/min, 60 min/day, 3 days/week, 12 weeks) and old high frequency exercise (20 m/min, 60 min/day, 5 days/week, 12 weeks). Exercise training indexes were obtained, including resting heart rate (HR), blood pressure (BP), plasma norepinephrine (NE), and heart weight (HW)-to-body weight (BW) ratios. The brain was removed and processed according to the immunofluorescence staining and western blot used to analyze the GABAergic terminal density, the proteins of GAD67, GABAA receptor and gephyrin in the PVN. There were significant changes in aged rats compared with those in the YC. Twelve weeks aerobic exercise training has volume-dependent ameliorated effects on cardiovascular parameters, autonomic nervous activities and GABAergic system functions. These data suggest that the density of GABAergic declines in the PVN is associated with imbalance in autonomic nervous activities in normal aging. Additionally, aerobic exercise can rescue aging-related an overactivity of the sympathetic nervous system and induces modifications the resting BP and HR to lower values via improving the GABAergic system in the PVN.
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Affiliation(s)
- Yan Li
- Department of Exercise Physiology, Beijing Sport UniversityBeijing, China
| | - Ziqi Zhao
- College of Life Sciences, University of Chinese Academy of SciencesBeijing, China
| | - Jiajia Cai
- Department of Exercise Physiology, Beijing Sport UniversityBeijing, China
| | - Boya Gu
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport UniversityBeijing, China
| | - Yuanyuan Lv
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport UniversityBeijing, China
| | - Li Zhao
- Department of Exercise Physiology, Beijing Sport UniversityBeijing, China.,Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport UniversityBeijing, China
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22
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Macey PM, Rieken NS, Ogren JA, Macey KE, Kumar R, Harper RM. Sex differences in insular cortex gyri responses to a brief static handgrip challenge. Biol Sex Differ 2017; 8:13. [PMID: 28435658 PMCID: PMC5397762 DOI: 10.1186/s13293-017-0135-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/11/2017] [Indexed: 01/02/2023] Open
Abstract
Background Cardiovascular disease varies between sexes, suggesting male-female autonomic control differences. Insular gyri help coordinate autonomic regulation and show a sex-dependent response to a sympathetic challenge. Methods We examined sex-related insular gyral responses to a short static handgrip exercise challenge eliciting parasympathetic withdrawal with functional magnetic resonance imaging (fMRI) during four 16-s challenges (80% maximum strength) in 23 healthy females (age; mean ± std 50 ± 8 years) and 40 males (46 ± 9 years). Heart rate (HR) and fMRI signals were compared with repeated measures ANOVA (P < 0.05). Additional analyses were performed with age and age interactions, as well as right-handed only subjects. Results Females showed higher resting HR than males, but smaller percent HR change increases to the challenges. All gyri showed fMRI patterns concurrent with an HR peak and decline to baseline. fMRI signals followed an anterior-posterior organization in both sexes, but lateralization varied by gyri and sex. All subjects showed greater signals in the anterior vs. posterior gyri (females 0.3%, males 0.15%). The middle gyri showed no lateralization in females but left-sided dominance in males (0.1%). The posterior gyri showed greater left than right activation in both sexes. The anterior-most gyri exhibited a prominent sex difference, with females showing a greater right-sided activation (0.2%) vs. males displaying a greater left-sided activation (0.15%). Age and handedness affected a minority of findings but did not alter the overall pattern of results. Conclusions The anterior insula plays a greater role in cardiovascular regulation than posterior areas during a predominantly parasympathetic withdrawal challenge, with opposite lateralization between sexes. In females, the left anterior-most gyrus responded distinctly from other regions than males. Those sex-specific structural and functional brain patterns may contribute over time to variations in cardiovascular disease between the sexes. Electronic supplementary material The online version of this article (doi:10.1186/s13293-017-0135-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paul M Macey
- UCLA School of Nursing, University of California at Los Angeles, 700 Tiverton Avenue, Los Angeles, CA 90095-1702 USA.,Brain Research Institute, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095 USA
| | - Nicholas S Rieken
- UCLA School of Nursing, University of California at Los Angeles, 700 Tiverton Avenue, Los Angeles, CA 90095-1702 USA
| | - Jennifer A Ogren
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095 USA
| | - Katherine E Macey
- UCLA School of Nursing, University of California at Los Angeles, 700 Tiverton Avenue, Los Angeles, CA 90095-1702 USA
| | - Rajesh Kumar
- Brain Research Institute, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095 USA.,Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095 USA.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095 USA
| | - Ronald M Harper
- Brain Research Institute, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095 USA.,Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095 USA
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23
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Abstract
Takotsubo syndrome is a unique clinical condition of acute heart failure and reversible left ventricular dysfunction frequently precipitated by sudden emotional or physical stress. There is growing evidence that exaggerated sympathetic stimulation is central to the pathogenesis of this syndrome. Precisely how catecholamines mediate myocardial stunning in takotsubo syndrome remains incompletely understood; but possible mechanisms include epicardial spasm, microvascular dysfunction, direct adrenergic-receptor-mediated myocyte injury, and systemic vascular effects that alter ventricular-arterial coupling. Risk factors that increase sympathetic tone and/or catecholamine sensitivity may render individuals particularly susceptible to takotsubo syndrome during episodes of acute stress.
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24
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Santulli G, Iaccarino G. Adrenergic signaling in heart failure and cardiovascular aging. Maturitas 2016; 93:65-72. [PMID: 27062709 PMCID: PMC5036981 DOI: 10.1016/j.maturitas.2016.03.022] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 12/15/2022]
Abstract
Both cardiovascular disease and aging are associated with changes in the sympathetic nervous system. Indeed, mounting evidence indicates that adrenergic receptors are functionally involved in numerous processes underlying both aging and cardiovascular disorders, in particular heart failure. This article will review the pathophysiological role of the sympathetic nervous system in heart failure and cardiovascular aging.
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Affiliation(s)
- Gaetano Santulli
- College of Physicians & Surgeons, Columbia University Medical Center, New York, NY, USA.
| | - Guido Iaccarino
- Division of Internal Medicine, Department of Medicine and Surgery, University of Salerno, Italy.
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25
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Macey PM, Rieken NS, Kumar R, Ogren JA, Middlekauff HR, Wu P, Woo MA, Harper RM. Sex Differences in Insular Cortex Gyri Responses to the Valsalva Maneuver. Front Neurol 2016; 7:87. [PMID: 27375549 PMCID: PMC4899449 DOI: 10.3389/fneur.2016.00087] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/27/2016] [Indexed: 12/26/2022] Open
Abstract
Sex differences in autonomic regulation may underlie cardiovascular disease variations between females and males. One key autonomic brain region is the insular cortex, which typically consists of five main gyri in each hemisphere, and shows a topographical organization of autonomic function across those gyri. The present study aims to identify possible sex differences in organization of autonomic function in the insula. We studied brain functional magnetic resonance imaging (fMRI) responses to a series of four 18-s Valsalva maneuvers in 22 healthy females (age ± SD: 50.0 ± 7.9 years) and 36 healthy males (45.3 ± 9.2 years). Comparisons of heart rate (HR) and fMRI signals were performed with repeated measures ANOVA (threshold P < 0.05 for all findings). All subjects achieved the target 30 mmHg expiratory pressure for all challenges. Typical HR responses were elicited by the maneuver, including HR increases from ~4 s into the strain period (Phase II) and rapid declines to below baseline 5–10 s, following strain release (Phase IV). Small, but significant, sex differences in HR percent change occurred during the sympathetic-dominant Phase II (female < male) and parasympathetic-dominant Phase IV (female > male, i.e., greater undershoot in males). The insular cortices showed similar patterns in all gyri, with greater signal decreases in males than females. Both sexes exhibited an anterior–posterior topographical organization of insular responses during Phase II, with anterior gyri showing higher responses than more posterior gyri. The exception was the right anterior-most gyrus in females, which had lower responses than the four other right gyri. Responses were lateralized, with right-sided dominance during Phase II in both sexes, except the right anterior-most gyrus in females, which showed lower responses than the left. The findings confirm the anterior and right-sided sympathetic dominance of the insula. Although sex differences were prominent in response magnitude, organization differences between males and females were limited to the right anterior-most gyrus, which showed a lower fMRI response in females vs. males (and vs. other gyri in females). The sex differences suggest a possible differing baseline state of brain physiology or tonic functional activity between females and males, especially in the right anterior-most gyrus.
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Affiliation(s)
- Paul M Macey
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA; Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA
| | - Nicholas S Rieken
- UCLA School of Nursing, University of California at Los Angeles , Los Angeles, CA , USA
| | - Rajesh Kumar
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA; Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jennifer A Ogren
- Department of Neurobiology, University of California at Los Angeles , Los Angeles, CA , USA
| | - Holly R Middlekauff
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles , Los Angeles, CA , USA
| | - Paula Wu
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, CA, USA; Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Mary A Woo
- UCLA School of Nursing, University of California at Los Angeles , Los Angeles, CA , USA
| | - Ronald M Harper
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA; Department of Neurobiology, University of California at Los Angeles, Los Angeles, CA, USA
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26
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Shufelt C, Elboudwarej O, Johnson BD, Mehta P, Bittner V, Braunstein G, Berga S, Stanczyk F, Dwyer K, Merz CNB. Carotid artery distensibility and hormone therapy and menopause: the Los Angeles Atherosclerosis Study. Menopause 2016; 23:150-7. [PMID: 26308234 PMCID: PMC4731269 DOI: 10.1097/gme.0000000000000510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Observational studies have suggested that arterial distensibility decreases during menopause; however, its relationship with hormone therapy use remains controversial. We prospectively studied distensibility and hormone therapy use at different menopause stages. METHODS One hundred sixty-one women (aged between 42 and 61 y) without cardiovascular disease underwent carotid artery measurements by ultrasound to calculate distensibility index at baseline and 3 years later. Menopause stage was classified at each visit as premenopausal, perimenopausal, and postmenopausal. Across 3 years of prospective observation, women were classified as remaining premenopausal, remaining postmenopausal, or transitioning (defined as change from premenopausal to perimenopausal, from premenopausal to postmenopausal, from perimenopausal to perimenopausal, or from perimenopausal to postmenopausal). RESULTS Distensibility declined across time at all menopause stages (P < 0.0001). Compared with postmenopausal women, premenopausal and transitioning/no hormone therapy women had more than twice the decline in distensibility index (P = 0.06 and P = 0.016, respectively), whereas transitioning/hormone therapy women did not differ in distensibility decline (P = 0.28). In a multivariate model, change in systolic blood pressure (P < 0.0001) and change in pulse pressure (P = 0.004) were independent predictors of distensibility index change and served as effect modulators. In an adjusted model, women in the premenopausal and transitioning/no hormone therapy groups had a significantly faster decline in distensibility index (P = 0.002 and P = 0.001, respectively) compared with postmenopausal women, whereas the transitioning/hormone therapy group did not (P = 0.21). CONCLUSIONS These findings confirm that the menopausal transition is associated with reduced vascular compliance. Hormone therapy is associated with better arterial distensibility only during the menopausal transition. Additional prospective studies are needed to confirm these findings and to determine whether hormone therapy use beyond the menopausal transition is related to distensibility.
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Affiliation(s)
- Chrisandra Shufelt
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Omeed Elboudwarej
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Puja Mehta
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Vera Bittner
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL
| | - Glenn Braunstein
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sarah Berga
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine
| | - Frank Stanczyk
- Departments of Obstetrics and Gynecology and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kathleen Dwyer
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
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Sex differences in the relationships between parasympathetic activity and pain modulation. Physiol Behav 2016; 154:40-8. [DOI: 10.1016/j.physbeh.2015.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/20/2015] [Accepted: 11/05/2015] [Indexed: 12/23/2022]
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Baroreceptor dysfunction, diabetes mellitus, and takotsubo syndrome: An intricate triangle needing exploration. Int J Cardiol 2015; 184:517-518. [DOI: 10.1016/j.ijcard.2015.02.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/26/2015] [Indexed: 11/19/2022]
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Yanagihara N, Seki M, Nakano M, Hachisuga T, Goto Y. Inverse correlation between the standard deviation of R-R intervals in supine position and the simplified menopausal index in women with climacteric symptoms. Menopause 2015; 21:669-72. [PMID: 24149918 DOI: 10.1097/gme.0000000000000094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Disturbance of autonomic nervous activity has been thought to play a role in the climacteric symptoms of postmenopausal women. This study was therefore designed to investigate the relationship between autonomic nervous activity and climacteric symptoms in postmenopausal Japanese women. METHODS The autonomic nervous activity of 40 Japanese women with climacteric symptoms and 40 Japanese women without climacteric symptoms was measured by power spectral analysis of heart rate variability using a standard hexagonal radar chart. The scores for climacteric symptoms were determined using the simplified menopausal index. RESULTS Sympathetic excitability and irritability, as well as the standard deviation of mean R-R intervals in supine position, were significantly (P < 0.01, 0.05, and 0.001, respectively) decreased in women with climacteric symptoms. There was a negative correlation between the standard deviation of mean R-R intervals in supine position and the simplified menopausal index score. The lack of control for potential confounding variables was a limitation of this study. CONCLUSIONS In climacteric women, the standard deviation of mean R-R intervals in supine position is negatively correlated with the simplified menopausal index score.
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Affiliation(s)
- Nobuyuki Yanagihara
- From the 1Department of Pharmacology, School of Medicine, and 2Department of Nursing of Human Broad Development, School of Health Sciences, University of Occupational and Environmental Health, Iseigaoka, Yahatanishi-ku, Kitakyushu, Japan; 3Department of Nursing, Faculty of Health Sciences, Junshin Gakuen University, Chikushiogaoka, Minami-ku, Fukuoka, Japan; 4Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Iseigaoka, Yahatanishi-ku, Kitakyushu, Japan; and 5Department of Anesthesiology, Aichi Medical University, School of Medicine, Azakarimata, Ooazaiwasaku, Nagakutecho Aichi-gun, Japan
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Ali A, Redfors B, Omerovic E. How baroreceptor dysfunction could predispose to the takotsubo syndrome. Int J Cardiol 2014; 182:105-6. [PMID: 25577743 DOI: 10.1016/j.ijcard.2014.12.148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 12/29/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Anwar Ali
- Department of Molecular and Clinical Medicine/C, Sahlgrenska Academy, Gothenburg University, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine/C, Sahlgrenska Academy, Gothenburg University, Sweden.
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine/C, Sahlgrenska Academy, Gothenburg University, Sweden
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[Application of power spectral analysis of heart rate variability to women with climacteric symptoms]. J UOEH 2014; 36:171-7. [PMID: 25224709 DOI: 10.7888/juoeh.36.171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Climacteric symptoms are multiple syndromes in menopausal women. It is known that autonomic nervous activity disorder plays an important role in these symptoms. In the present brief review, we report our recent studies of the relation between climacteric symptoms and autonomic nervous system balance measured by power spectral analysis of heart rate variability (HRV) using a standard hexagon radar chart. The sympathetic excitability and irritability, and the standard deviation of mean R-R intervals in the supine position were significantly decreased in women with climacteric symptoms compared to control women without climacteric symptoms. There was a negative correlation (r = -0.363, P = 0.0167) between the standard deviation of mean R-R intervals in the supine position and the simplified menopausal index score. These results show suggest a close relation between climacteric symptoms and autonomic nervous activities, and our power spectral analysis of HRV, which provides a standard hexagonal radar chart composed of three sympathetic and three parasympathetic parameters, may be helpful in the diagnosis and treatment of climacteric symptoms in menopausal women.
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Incidence and clinical characteristics of takotsubo cardiomyopathy post-aneurysmal subarachnoid hemorrhage. Int J Cardiol 2014; 176:1362-4. [DOI: 10.1016/j.ijcard.2014.07.279] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 11/21/2022]
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33
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Music induces different cardiac autonomic arousal effects in young and older persons. Auton Neurosci 2014; 183:83-93. [DOI: 10.1016/j.autneu.2014.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 02/13/2014] [Accepted: 02/18/2014] [Indexed: 11/24/2022]
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de Boer HD, Booij LHDJ. Takotsubo cardiomyopathy and anaesthesia: case report and review of the literature. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2014; 61:284-289. [PMID: 23796841 DOI: 10.1016/j.redar.2013.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 04/15/2013] [Accepted: 04/17/2013] [Indexed: 06/02/2023]
Abstract
Takotsubo cardiomyopathy is an acute syndrome characterized by cardiac failure from disturbances in the contractility of the left ventricle. It is presumably caused by sympathetic over stimulation. We describe a case of postoperatively developed Takotsubo cardiomyopathy in a 69-year-old female. The syndrome developed in connection with awareness during complete residual paralysis. The literature on this syndrome is reviewed and implications for anaesthesia described.
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Affiliation(s)
- H D de Boer
- Department of Anaesthesiology and Pain Medicine, Martini Hospital, Groningen, The Netherlands.
| | - L H D J Booij
- Department of Anaesthesiology, Pain Medicine and Palliative Care, Radboud University Medical Centre, Nijmegen, The Netherlands
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Vaccaro A, Despas F, Delmas C, Lairez O, Lambert E, Lambert G, Labrunee M, Guiraud T, Esler M, Galinier M, Senard JM, Pathak A. Direct evidences for sympathetic hyperactivity and baroreflex impairment in Tako Tsubo cardiopathy. PLoS One 2014; 9:e93278. [PMID: 24667435 PMCID: PMC3965544 DOI: 10.1371/journal.pone.0093278] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 03/04/2014] [Indexed: 12/18/2022] Open
Abstract
Background The exact pathophysiology of Tako-Tsubo cardiomyopathy (TTC) remains unknown but a role for sympathetic hyperactivity has been suggested. Up to now, no direct evidence of sympathetic nerve hyperactivity has been established nor involvement of sympathetic baroreflex identified. The aim of our study was to determine, by direct sympathetic nerve activity (SNS) recording if sympathetic nervous system activity is increased and spontaneous baroreflex control of sympathetic activity reduced in patients with TTC. Methods We included 13 patients who presented with TTC and compared their SNS activity and spontaneous baroreflex control of sympathetic activity with that of 13 control patients with acutely decompensated chronic heart failure. SNS activity was evaluated by microneurography, a technique assessing muscle sympathetic nerve activity (MSNA). Spontaneous baroreflex control of sympathetic activity was evaluated as the absolute value of the slope of the regression line representing the relationship between spontaneous diastolic blood pressure values and concomitant SNS activity. Control patients were matched for age, sex, left ventricular ejection fraction and creatinine clearance. Results The mean age of the patients with TTC was 80 years, all patients were women. There were no significant differences between the two groups of patients for blood pressure, heart rate or oxygen saturation level. TTC patients presented a significant increase in sympathetic nerve activity (MSNA median 63.3 bursts/min [interquartile range 61.3 to 66.0] vs median 55.7 bursts/min [interquartile range 51.0 to 61.7]; p = 0.0089) and a decrease in spontaneous baroreflex control of sympathetic activity compared to matched control patients (spontaneous baroreflex control of sympathetic activity median 0.7%burst/mmHg [interquartile range 0.4 to 1.9] vs median 2.4%burst/mmHg [interquartile range 1.8 to 2.9]; p = 0.005). Conclusions We report for the first time, through direct measurement of sympathetic nerve activity, that patients with TTC exhibit elevated SNS activity associated with a decrease in spontaneous baroreflex control of sympathetic activity. These data may explain the pathophysiology and clinical presentation of patient with TTC.
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Affiliation(s)
- Angelica Vaccaro
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- C.I.C., Clinical Investigation Center, University Hospital of Toulouse, Toulouse, France
| | - Fabien Despas
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Toulouse University III Paul Sabatier, Toulouse, France
- Clinical Pharmacology Department, University Hospital of Toulouse, Toulouse, France
| | - Clement Delmas
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Olivier Lairez
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Toulouse University III Paul Sabatier, Toulouse, France
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Elisabeth Lambert
- Human Neurotransmitter Laboratory, Baker IDI Heart and Diabetes Institute and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Gavin Lambert
- Human Neurotransmitter Laboratory, Baker IDI Heart and Diabetes Institute and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Marc Labrunee
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Toulouse University III Paul Sabatier, Toulouse, France
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Thibaut Guiraud
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Toulouse University III Paul Sabatier, Toulouse, France
| | - Murray Esler
- Human Neurotransmitter Laboratory, Baker IDI Heart and Diabetes Institute and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michel Galinier
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Toulouse University III Paul Sabatier, Toulouse, France
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Jean Michel Senard
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Toulouse University III Paul Sabatier, Toulouse, France
- Clinical Pharmacology Department, University Hospital of Toulouse, Toulouse, France
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Atul Pathak
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Toulouse University III Paul Sabatier, Toulouse, France
- Clinical Pharmacology Department, University Hospital of Toulouse, Toulouse, France
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
- Human Neurotransmitter Laboratory, Baker IDI Heart and Diabetes Institute and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- C.I.C., Clinical Investigation Center, University Hospital of Toulouse, Toulouse, France
- * E-mail:
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36
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Affiliation(s)
- Manja Reimann
- Zentrum fur Klinische Neurowissenschaften, Kilnik und Polikilnik fur Neurologie, Universitatsklinikum Carl Gustav Carus, Dresden.
| | | | - Tjalf Ziemssen
- Tjalf Ziemssen, Zentrum fur Klinische Neurowissenschaften, Klinik und Poliklinik fUr Neurologie, Universitatsklinikum Carl Gustav Carus, Dresden
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Salivary alpha amylase activity in human beings of different age groups subjected to psychological stress. Indian J Clin Biochem 2013; 29:485-90. [PMID: 25298630 DOI: 10.1007/s12291-013-0388-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
Abstract
Salivary alpha-amylase (sAA) has been proposed as a sensitive non-invasive biomarker for stress-induced changes in the body that reflect the activity of the sympathetic nervous system. Though several experiments have been conducted to determine the validity of this salivary component as a reliable stress marker in human subjects, the effect of stress induced changes on sAA level in different age groups is least studied. This article reports the activity of sAA in human subjects of different age groups subjected to psychological stress induced through stressful video clip. Differences in sAA level based on sex of different age groups under stress have also been studied. A total of 112 subjects consisting of both the male and female subjects, divided into two groups on basis of age were viewed a video clip of corneal transplant surgery as stressor. Activity of sAA from saliva samples of the stressed subjects were measured and compared with the activity of the samples collected from the subjects before viewing the clip. The age ranges of subjects were 18-25 and 40-60 years. The sAA level increased significantly in both the groups after viewing the stressful video. The increase was more pronounced in the younger subjects. The level of sAA was comparatively more in males than females in the respective groups. No significant change in sAA activity was observed after viewing the soothed video clip. Significant increase of sAA level in response to psychological stress suggests that it might act as a reliable sympathetic activity biochemical marker in different stages of human beings.
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Souza HCD, Tezini GCSV. Autonomic Cardiovascular Damage during Post-menopause: the Role of Physical Training. Aging Dis 2013; 4:320-8. [PMID: 24307965 DOI: 10.14336/ad.2013.0400320] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 08/20/2013] [Accepted: 08/28/2013] [Indexed: 12/23/2022] Open
Abstract
Menopause is part of the aging process and is characterized by the natural cessation of menstruation; during this time, the production of ovarian hormones, especially estrogen, is sharply reduced. This reduction can cause symptoms and disorders that affect most women and can interfere with their quality of life. Women are also more susceptible to cardiovascular diseases during this period, considering that these ovarian hormones would be associated with a protective effect on the cardiovascular system, by acting at various levels, contributing to the body homeostasis. Among several effects on the cardiovascular system, the ovarian hormones seem to play an important role in the autonomic control of heart rate and blood pressure. A reduction in ovarian hormones causes an autonomic imbalance and increases the risk of cardiovascular diseases. In fact, this increased risk is justified by the key role the autonomic nervous system plays in all cardiac regulatory mechanisms, exerting a tonic and reflexive influence on the main variables of the cardiovascular system. The autonomic system controls various cardiovascular parameters, such as the modulation of heart rate and blood pressure, myocardial contractility and venous capacitance, directly participating in the regulation of cardiac output. Over the years, the standard treatment for menopause symptoms and disorders has been hormone replacement therapy (HRT). However, many studies have indicated the risks of HRT, which justify the need for new non-pharmacological therapies. To this end, physical training, mainly aerobic, has been applied with excellent results on the cardiovascular autonomic nervous system, as it reduces the risk of cardiac diseases and improves the survival rate with direct beneficial effects on the quality of life of these women during the aging process.
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Affiliation(s)
- Hugo C D Souza
- Exercise Physiology Laboratory of the Department of Biomechanics, Medicine and Rehabilitation, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Compare A, Bigi R, Orrego PS, Proietti R, Grossi E, Steptoe A. Type D personality is associated with the development of stress cardiomyopathy following emotional triggers. Ann Behav Med 2013; 45:299-307. [PMID: 23494256 DOI: 10.1007/s12160-013-9474-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Stress cardiomyopathy (SCM) can be triggered by emotional events. Recently, type D personality has been established as an independent predictor of acute cardiac adverse events. PURPOSE We sought to examine whether type D personality can be identified in SCM patients. METHODS A case-control study with 37 SCM patients, 37 myocardial infarction (AMI) patients, who both experienced emotional triggering, and 37 SCM patients without emotional triggers was performed. The DS14 and Interview for Recent Life Events were administered. RESULTS Twenty-eight (76 %) SCM emotional trigger patients were categorized as type D compared with 13 (43 %) SCM patients without emotional trigger and 12 (32 %) AMI patients (p < 0.001). SCM patients with emotional triggers had higher scores on the social inhibition subscale than the other patient groups. CONCLUSIONS The present study highlights the possible link between type D, with a specific key role for social inhibition component, and increased biological reactivity to acute emotional stress.
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Ikutomi M, Yamasaki M, Matsusita M, Watari Y, Arashi H, Endo G, Yamaguchi JI, Ohnishi S. Takotsubo cardiomyopathy in siblings. Heart Vessels 2013; 29:119-22. [PMID: 23563753 DOI: 10.1007/s00380-013-0345-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 03/22/2013] [Indexed: 10/27/2022]
Abstract
We report the case of apical ballooning syndrome (ABS) in a female sibling. A 64-year-old woman was admitted to our hospital with sudden-onset chest pain. Cardiac enzymes were mildly elevated and an electrocardiogram showed broad ST-T changes. Emergency coronary angiography revealed no culprit lesion and left ventriculography demonstrated focal akinesis of the apical wall, which was consistent with ABS. Myocardial functional sympathetic innervations assessed using [(123)I]metaiodobenzylguanidine was severely impaired in the apical region. Her clinical symptoms and cardiac dysfunction recovered spontaneously. Just 1 year prior to our patient's cardiac event, her elder sister had the same symptoms and was also diagnosed with ABS. Both sisters were postmenopausal. The familial case of ABS is exceedingly rare, but these cases suggest a possible genetic etiology.
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Affiliation(s)
- Masayasu Ikutomi
- NTT Medical Center, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan,
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Tezini GCSV, Dias DPM, Souza HCD. Aerobic physical training has little effect on cardiovascular autonomic control in aging rats subjected to early menopause. Exp Gerontol 2012. [PMID: 23201548 DOI: 10.1016/j.exger.2012.11.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We investigated and compared the effects of physiological menopause (PM) and early menopause (EM) and the adaptations promoted by physical training on the cardiovascular autonomic control of aged rats. Female Wistar rats (N=72) were assigned to 3 groups: control (22 weeks old rats, undergoing sham surgery in the 10th week of life), PM (82 weeks old rats, undergoing sham surgery in the 10th week of life) and EM (82 weeks old rats, undergoing ovariectomy in the 10th week of life). In each group, half of the rats were subjected to swimming training over a period of 10 weeks. Sedentary PM and EM groups had higher basal mean arterial pressure (MAP) and heart rate (HR) and lower intrinsic HR compared to the sedentary control group. Physical training reduced MAP in PM group. All trained groups had lower basal HR; however, only control and PM-trained groups showed decreased intrinsic HR. The assessment of cardiac autonomic balance showed that PM and EM sedentary groups exhibited sympathetic predominance compared to control group. After physical training, only EM group presented sympathetic predominance. HR variability (pulse interval) was similar among all sedentary groups. However, control and PM-trained groups showed lower power in low frequency band (LF; 0.2-0.75 Hz) and higher power in high frequency band (HF; 0.75-3.0 Hz). The analysis of systolic arterial pressure variability revealed that PM and EM sedentary groups had higher LF power. However, PM group showed lower LF power following physical training. Finally, PM and EM groups had a reduction in spontaneous baroreflex sensitivity, that was attenuated by physical training. The overall results suggest that PM or EM promotes similar negative effects on MAP, HR and cardiovascular autonomic control. However, unlike the PM group, physical training was not able to mitigate all negative effects of EM on cardiovascular autonomic control.
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Affiliation(s)
- Geisa C S V Tezini
- Exercise Physiology Laboratory, Department of Biomechanics, Medicine and Rehabilitation, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Wittstein IS. Stress cardiomyopathy: a syndrome of catecholamine-mediated myocardial stunning? Cell Mol Neurobiol 2012; 32:847-57. [PMID: 22297544 DOI: 10.1007/s10571-012-9804-8] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 01/16/2012] [Indexed: 12/15/2022]
Abstract
During the past few years, a novel syndrome of heart failure and transient left ventricular systolic dysfunction precipitated by acute emotional or physical stress has been described. While patients with "stress cardiomyopathy"(SCM) typically present with signs and symptoms that resemble an acute coronary syndrome, it has become clear that this syndrome has unique clinical features that can readily be distinguished from acute infarction.In particular, in contrast to the irreversible myocardial injury seen with infarction, the myocardial dysfunction of SCM is completely reversible and occurs in the absence of plaque rupture and coronary thrombosis. There is increasing evidence that exaggerated sympathetic stimulation may play a pathogenic role in the development of SCM. Plasma catecholamine levels have been found to be markedly elevated in some patients with SCM, and the syndrome has been observed in other clinical states of catecholamine excess such as central neurologic injury and pheochromocytoma.Further, intravenous catecholamines can precipitate SCM in humans and can reproduce the syndrome in animal models. The precise mechanism in which excessive sympathetic stimulation may result in transient left ventricular dysfunction remains controversial. Abnormal myocardial blood flow due to sympathetically mediated microvascular dysfunction has been suggested and is supported by decreased coronary flow reserve during the acute phase of this syndrome. An alternative explanation is the direct effect of catecholamines on cardiac myocytes, possibly through cyclic AMP-mediated calcium overload. This manuscript will review the clinical and diagnostic features of SCM and will summarize the evidence supporting a sympathetically mediated pathogenesis. Clinical risk factors that appear to increase susceptibility to SCM, possibly by modulating myocyte and microvascular sensitivity to catecholamines, will also be highlighted.
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Affiliation(s)
- Ilan S Wittstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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43
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P-wave parameters and cardiac repolarization indices: Does menopausal status matter? J Cardiol 2012; 60:333-7. [DOI: 10.1016/j.jjcc.2012.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 04/01/2012] [Accepted: 04/05/2012] [Indexed: 11/17/2022]
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Edgell H, Robertson AD, Hughson RL. Hemodynamics and brain blood flow during posture change in younger women and postmenopausal women compared with age-matched men. J Appl Physiol (1985) 2012; 112:1482-93. [DOI: 10.1152/japplphysiol.01204.2011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Increased incidence of orthostatic hypotension and presyncopal symptoms in young women could be related to hormonal factors that might be isolated by comparing cardiovascular and cerebrovascular responses to postural change in young and older men and women. Seven young women, 11 young men, 10 older women (>1 yr postmenopausal, no hormone therapy), and 9 older men participated in a supine-to-sit-to-stand test while measuring systemic hemodynamics, end-tidal Pco2, and blood flow velocity of the middle cerebral artery (MCA). Women had a greater reduction in stroke volume index compared with age-matched men (change from supine to standing: young women: −22.9 ± 1.6 ml/m2; young men: −14.4 ± 2.4 ml/m2; older women: −17.4 ± 3.3 ml/m2; older men: −13.8 ± 2.2 ml/m2). This was accompanied by offsetting changes in heart rate, particularly in young women, resulting in no age or sex differences in cardiac output index. Mean arterial pressure (MAP) was higher in older subjects and increased with movement to upright postures. Younger men and women had higher forearm vascular resistance that increased progressively in the upright posture compared with older men and women. There was no difference between sexes or ages in total peripheral resistance index. Women had higher MCA velocity, but both sexes had reduced MCA velocity while upright, which was a function of reduced blood pressure at the MCA and a significant reduction in end-tidal Pco2. The reductions in stroke volume index suggested impaired venous return in women, but augmented responses of heart rate and forearm vascular resistance protected MAP in younger women. Overall, these results showed significant sex and age-related differences, but compensatory mechanisms preserved MAP and MCA velocity in young women.
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Affiliation(s)
- H. Edgell
- Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario; and
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - A. D. Robertson
- Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario; and
| | - R. L. Hughson
- Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario; and
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Veen G, Giltay EJ, Vreeburg SA, Licht CM, Cobbaert CM, Zitman FG, Penninx BW. Determinants of salivary evening alpha-amylase in a large sample free of psychopathology. Int J Psychophysiol 2012; 84:33-8. [DOI: 10.1016/j.ijpsycho.2012.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 12/30/2011] [Accepted: 01/04/2012] [Indexed: 01/09/2023]
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Yanes LL, Romero DG, Iliescu R, Reckelhoff JF. A single pill to treat postmenopausal hypertension? Not yet. Curr Top Med Chem 2011; 11:1736-41. [PMID: 21463249 DOI: 10.2174/156802611796117667] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 08/14/2010] [Indexed: 11/22/2022]
Abstract
Postmenopausal women make up one of the fastest growing populations in the United States. Women typically have a higher incidence of cardiovascular disease following menopause. One of the major risk factors for cardiovascular disease is hypertension, and after menopause, blood pressure (BP) increases progressively in women. Also after menopause, the progression of renal disease increases in women compared with aged matched men. However, the mechanism(s) responsible for the post-menopausal increase in BP and renal injury are yet to be elucidated. Moreover the best therapeutic options to treat postmenopausal hypertension in women are not clear. Hypertension in postmenopausal women are usually associated with other cardiovascular risk factors, such as dyslipidemias, visceral obesity and endothelial dysfunction. Recently it became apparent that in a large number of hypertensive postmenopausal women, their BP is not well controlled with conventional antihypertensive medications. A clear understanding of the complex pathogenesis of postmenopausal hypertension is needed in order to offer the best therapeutic options for these women.
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Affiliation(s)
- Licy L Yanes
- Department of Physiology and Biophysics, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216-4505, USA.
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Campana LM, Clifford GD, Trinder J, Pittman SD, Malhotra A. A possible method to predict response to non-pharmacological insomnia therapy. J Clin Sleep Med 2011; 7:370-5. [PMID: 21897773 DOI: 10.5664/jcsm.1192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To determine if electrocardiographic parameters are predictive of response to non-pharmacological insomnia therapy. DESIGN Secondary analysis of heart rate parameters from a double blind, randomized, sham-controlled trial at multiple study sites. SETTING Six sites in the United States were used for the data collection. PARTICIPANTS One hundred ninety-eight healthy subjects with no sleep disorders. INTERVENTIONS Subjects were studied on 2 consecutive nights, a baseline night and a therapy night. On the therapy night, subjects were phase advanced 4 h and randomized to receive either sham or vestibular stimulation, an experimental therapy for insomnia. MEASUREMENTS AND RESULTS ECG data were recorded and analyzed for the 5-min periods preceding and following sleep onset. Analyses were conducted on those who did and did not respond to therapy, as defined by latency from bedtime to persistent sleep (LPS). Responders to therapy were found to have higher low-frequency (LF) power at baseline during wakefulness than non-responders, and responders had higher high-frequency (HF) power during therapy than non-responders on therapy. Furthermore, responders > 35 y had elevated LF power at baseline than non-responders > 35 y (p < 0.05). No differences were seen in the sham group in identical analyses, ruling out a nonspecific effect of sleep onset. CONCLUSIONS Heart rate variability analyses indicate that differences exist between those who respond to insomnia therapy and those that do not, particularly in an older subset of subjects. Further research into the use of ECG and other physiological parameters to stratify response to therapeutic interventions is warranted.
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Lehto HR, Lehto S, Havulinna AS, Ketonen M, Lehtonen A, Kesäniemi YA, Airaksinen KJ, Salomaa V. Sex differences in short- and long-term case-fatality of myocardial infarction. Eur J Epidemiol 2011; 26:851-61. [PMID: 21717199 DOI: 10.1007/s10654-011-9601-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 06/17/2011] [Indexed: 11/30/2022]
Abstract
Declining trends in case fatality (CF) of MI events have been generally reported in western countries. It is, however, not clear whether the development has been equally beneficial in both sexes. Data from two large population based registers, FINAMI and the Finnish National Cardiovascular Disease Register (CVDR) were used to determine whether the CF of incident MI events has declined less in women than in men. All patients aged 35 and over were included. CF was calculated for different time periods after the onset of the MI event, the main emphasis was in pre-hospital, 28-day, and 1-year CF. Figures were compared between two study periods: 1994-1996 and 2000-2002. A total of 6,342 incident MI events were recorded in FINAMI and 117,632 events in CVDR during the study periods. Comparison between the two study periods showed that the CF was generally declining. However, a slower decline in short-term CF was seen among young (aged<55 years) women (P for sex by study period interaction in pre-hospital CF=0.028 in FINAMI and 0.003 in CVDR, and for 28-day CF P=0.016 in FINAMI and <0.0001 in CVDR). In conclusion, the short and long-term prognosis of MI events has improved in both sexes. Pre-hospital CF has declined less among younger women than among men and among older women. This slower decline in early CF was responsible for the slower improvement in 28-day and 1-year prognosis in young women.
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Affiliation(s)
- Hanna-Riikka Lehto
- Department of Medicine, University of Kuopio and Kuopio University Hospital, 70210, Kuopio, Finland.
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Rubinow DR, Girdler SS. Hormones, heart disease, and health: individualized medicine versus throwing the baby out with the bathwater. Depress Anxiety 2011; 28:E1-E15. [PMID: 21648024 DOI: 10.1002/da.20833] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
It is increasingly axiomatic that depression has widespread adverse physiological effects and, conversely, that a variety of physiological systems impact the risk for developing depression. This convergence of depression and altered physiology is particularly dramatic during midlife--a time during which reproductive failure presages dramatic increases in prevalence of both heart disease and depression. The potentially meaningful and illuminating links between estrogen deficiency, cardiovascular disease (CVD), and depression have largely been obscured, first by assertions, subsequently repudiated, that the perimenopause was not a time of increased risk of depression, and more recently by the denegration of hormone replacement therapy by initial reports of the Women's Health Initiative. Increasingly, however, research has led to unavoidable conclusions that CVD and depression share common, mediating pathogenic processes and that these same processes are dramatically altered by the presence or absence of estrogen (E2). This review summarizes data supporting these contentions with the intent of placing depression and estrogen therapy in their proper physiologic context.
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Affiliation(s)
- David R Rubinow
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina 27599. USA
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Rubinow DR, Girdler SS. Hormones, heart disease, and health: individualized medicine versus throwing the baby out with the bathwater. Depress Anxiety 2011; 28:282-96. [PMID: 21456038 DOI: 10.1002/da.20810] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
It is increasingly axiomatic that depression has widespread adverse physiological effects, and conversely that a variety of physiological systems impact the risk for developing depression. This convergence of depression and altered physiology is particularly dramatic during midlife-a time during which reproductive failure presages dramatic increases in prevalence of both heart disease and depression. The potentially meaningful and illuminating links between estrogen (E2) deficiency, cardiovascular disease (CVD), and depression have largely been obscured, first by assertions, subsequently repudiated that the perimenopause was not a time of increased risk of depression, and more recently by the denegration of hormone replacement therapy by initial reports of the Women's Health Initiative. Increasingly, however, research has led to unavoidable conclusions that CVD and depression share common and mediating pathogenic processes and that these same processes are dramatically altered by the presence or absence of E2. This review summarizes data supporting this contention with the intent of placing depression and E2 therapy in their proper physiologic context.
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Affiliation(s)
- David R Rubinow
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA
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