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Pikkarainen K, Valtonen RIP, Hintsala HE, Kiviniemi A, Crandall CG, Perkiömäki J, Hautala AJ, Tulppo MP, Jaakkola JJK, Ikäheimo TM. Baroreflex sensitivity following acute upper-body exercise in the cold among stable coronary artery disease patients. Front Physiol 2023; 14:1184378. [PMID: 37900953 PMCID: PMC10611474 DOI: 10.3389/fphys.2023.1184378] [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: 03/11/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Background: A cold environment and exercise separately affect the autonomic nervous system (ANS), baroreflex sensitivity (BRS), and blood pressure variability (BPV) but their combined effects on post-exercise recovery are not known. Our cross-over trial examined these responses following upper-body static and dynamic exercise performed in a cold and neutral environment in patients with coronary artery disease (CAD). Methods: 20 patients with stable coronary artery disease performed both graded static (10%-30% of maximal voluntary contraction) and dynamic (light, moderate and high perceived intensity) upper-body exercise at -15°C and +22°C for 30 min. Electrocardiogram and continuous blood pressure were measured to compute post-exercise (10 and 30 min after exercise) spectral powers of heart rate (HR), blood pressure variability and BRS at low (0.04-0.15 Hz) and high (0.15-0.4 Hz) frequencies. Results: Static upper-body exercise performed in a cold environment increased post-exercise high frequency (HF) spectral power of heart rate (HF RR) (p < 0.001) and reduced heart rate (p = 0.001) and low-to-high frequency (LF/HF) ratio (p = 0.006) more than in a neutral environment. In addition, post-exercise mean BRS (p = 0.015) and high frequency BRS (p = 0.041) increased more following static exercise in the cold than in a neutral environment. Dynamic upper-body exercise performed in a cold environment reduced post-exercise HF BRS (p = 0.019) and systolic blood pressure (p = 0.003). Conclusion: Static upper-body exercise in the cold increased post-exercise BRS and overall vagal activity but without reduced systolic blood pressure. Dynamic upper-body exercise in the cold reduced post-exercise vagal BRS but did not affect the other parameters. The influence of cold exposure on post-exercise autonomic and cardiovascular responses following static upper-body exercise require further studies. This information helps understanding why persons with cardiovascular diseases are vulnerable to low environmental temperature. ClinicalTrials.gov: NCT02855905 (04/08/2016).
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Affiliation(s)
- Kalle Pikkarainen
- Center for Environmental and Respiratory Health Research, Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Rasmus I P Valtonen
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | | | - Antti Kiviniemi
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Craig G Crandall
- Department of Internal Medicine, Texas Health Presbyterian Hospital, Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Juha Perkiömäki
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Arto J Hautala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Mikko P Tulppo
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Tiina M Ikäheimo
- Center for Environmental and Respiratory Health Research, Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Debnath S, Levy TJ, Bellehsen M, Schwartz RM, Barnaby DP, Zanos S, Volpe BT, Zanos TP. A method to quantify autonomic nervous system function in healthy, able-bodied individuals. Bioelectron Med 2021; 7:13. [PMID: 34446089 PMCID: PMC8394599 DOI: 10.1186/s42234-021-00075-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/20/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The autonomic nervous system (ANS) maintains physiological homeostasis in various organ systems via parasympathetic and sympathetic branches. ANS function is altered in common diffuse and focal conditions and heralds the beginning of environmental and disease stresses. Reliable, sensitive, and quantitative biomarkers, first defined in healthy participants, could discriminate among clinically useful changes in ANS function. This framework combines controlled autonomic testing with feature extraction during physiological responses. METHODS Twenty-one individuals were assessed in two morning and two afternoon sessions over two weeks. Each session included five standard clinical tests probing autonomic function: squat test, cold pressor test, diving reflex test, deep breathing, and Valsalva maneuver. Noninvasive sensors captured continuous electrocardiography, blood pressure, breathing, electrodermal activity, and pupil diameter. Heart rate, heart rate variability, mean arterial pressure, electrodermal activity, and pupil diameter responses to the perturbations were extracted, and averages across participants were computed. A template matching algorithm calculated scaling and stretching features that optimally fit the average to an individual response. These features were grouped based on test and modality to derive sympathetic and parasympathetic indices for this healthy population. RESULTS A significant positive correlation (p = 0.000377) was found between sympathetic amplitude response and body mass index. Additionally, longer duration and larger amplitude sympathetic and longer duration parasympathetic responses occurred in afternoon testing sessions; larger amplitude parasympathetic responses occurred in morning sessions. CONCLUSIONS These results demonstrate the robustness and sensitivity of an algorithmic approach to extract multimodal responses from standard tests. This novel method of quantifying ANS function can be used for early diagnosis, measurement of disease progression, or treatment evaluation. TRIAL REGISTRATION This study registered with Clinicaltrials.gov , identifier NCT04100486 . Registered September 24, 2019, https://www.clinicaltrials.gov/ct2/show/NCT04100486 .
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Affiliation(s)
- Shubham Debnath
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Todd J Levy
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Mayer Bellehsen
- Department of Psychiatry, Unified Behavioral Health Center and World Trade Center Health Program, Northwell Health, Bay Shore, NY, USA
| | - Rebecca M Schwartz
- Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Center for Disaster Health, Trauma, and Resilience, New York, NY, USA
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Douglas P Barnaby
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Northwell Health, Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Bruce T Volpe
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Northwell Health, Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Theodoros P Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA.
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Jungen C, Alken FA, Eickholt C, Scherschel K, Kuklik P, Klatt N, Schwarzl J, Moser J, Jularic M, Akbulak RO, Schaeffer B, Willems S, Meyer C. Respiratory sinus arrhythmia is reduced after pulmonary vein isolation in patients with paroxysmal atrial fibrillation. Arch Med Sci 2020; 16:1022-1030. [PMID: 32863990 PMCID: PMC7444695 DOI: 10.5114/aoms.2019.83883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/11/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Respiratory sinus arrhythmia (RSA) describes heart rate (HR) changes in synchrony with respiration. It is relevant for exercise capacity and mechanistically linked with the cardiac autonomic nervous system. After pulmonary vein isolation (PVI), the current therapy of choice for patients with paroxysmal atrial fibrillation (AF), the cardiac vagal tone is often diminished. We hypothesized that RSA is modulated by PVI in patients with paroxysmal AF. MATERIAL AND METHODS Respiratory sinus arrhythmia, measured by using a deep breathing test and heart rate variability parameters, was studied in 10 patients (64 ±3 years) with paroxysmal AF presenting in stable sinus rhythm for their first catheter-based PVI. Additionally, heart rate dynamics before and after PVI were studied during sympathetic/parasympathetic coactivation by using a cold-face test. All tests were performed within 24 h before and 48 h after PVI. RESULTS After PVI RSA (E/I difference: 7.9 ±1.0 vs. 3.5 ±0.6 bpm, p = 0.006; E/I ratio: 1.14 ±0.02 vs. 1.05 ±0.01, p = 0.003), heart rate variability (SDNN: 31 ±3 vs. 14 ±3 ms, p = 0.006; RMSSD: 17 ±2 vs. 8 ±2 ms, p = 0.002) and the HR response to sympathetic/parasympathetic coactivation (10.2 ±0.7% vs. 5.7 ±1.1%, p = 0.014) were diminished. The PVI-related changes in RSA correlated with the heart rate change during sympathetic/parasympathetic coactivation before vs. after PVI (E/I difference: r = 0.849, p = 0.002; E/I ratio: r = 0.786, p = 0.007). One patient with vagal driven arrhythmia experienced AF recurrence during follow-up (mean: 6.5 ±0.6 months). CONCLUSIONS Respiratory sinus arrhythmia is reduced after PVI in patients with paroxysmal AF. Our findings suggest that this is related to a decrease in cardiac vagal tone. Whether and how this affects the clinical outcome including exercise capacity need to be determined.
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Affiliation(s)
- Christiane Jungen
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Fares-Alexander Alken
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Scherschel
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pawel Kuklik
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Niklas Klatt
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Schwarzl
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Moser
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ruken Oezge Akbulak
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Schaeffer
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Meyer
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Johnson BD, O'Leary MC, McBryde M, Sackett JR, Schlader ZJ, Leddy JJ. Face cooling exposes cardiac parasympathetic and sympathetic dysfunction in recently concussed college athletes. Physiol Rep 2019; 6:e13694. [PMID: 29741235 PMCID: PMC5941219 DOI: 10.14814/phy2.13694] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 12/24/2022] Open
Abstract
We tested the hypothesis that concussed college athletes (CA) have attenuated parasympathetic and sympathetic responses to face cooling (FC). Eleven symptomatic CA (age: 20 ± 2 years, 5 women) who were within 10 days of concussion diagnosis and 10 healthy controls (HC; age: 24 ± 4 years, 5 women) participated. During FC, a plastic bag filled with ice water (~0°C) was placed on the forehead, eyes, and cheeks for 3 min. Heart rate (ECG) and blood pressure (photoplethysmography) were averaged at baseline and every 60 sec during FC. High‐frequency (HF) power was obtained from spectral analysis of the R‐R interval. Data are presented as a change from baseline. Baseline heart rate (HC: 61 ± 12, CA: 57 ± 12 bpm; P = 0.69), mean arterial pressure (MAP) (HC: 94 ± 10, CA: 96 ± 13 mmHg; P = 0.74), and HF (HC: 2294 ± 2314, CA: 2459 ± 2058 msec2; P = 0.86) were not different between groups. Heart rate in HC decreased at 2 min (−7 ± 11 bpm; P = 0.02) but did not change in CA (P > 0.43). MAP increased at 1 min (HC: 12 ± 6, CA: 6 ± 6 mmHg), 2 min (HC: 21 ± 7, CA: 11 ± 7 mmHg), and 3 min (HC: 20 ± 6, CA: 13 ± 7 mmHg) in both groups (P < 0.01 for all) but the increase was greater at each interval in HC (P < 0.02). HF increased at 1 min (12354 ± 11489 msec2; P < 0.01) and 2 min (5832 ± 8002 msec2; P = 0.02) in HC but did not change in CA (P > 0.58). The increase in HF at 1 min was greater in HC versus CA (P < 0.01). These data indicate that symptomatic concussed patients have impaired cardiac parasympathetic and sympathetic activation.
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Affiliation(s)
- Blair D Johnson
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Morgan C O'Leary
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Muhamed McBryde
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - James R Sackett
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Zachary J Schlader
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - John J Leddy
- UBMD, Department of Orthopaedics and Sports Medicine, University at Buffalo, Buffalo, New York
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Effects of elastomer roller stimulation of facial skin on autonomic nervous activity. Clin Auton Res 2018; 29:127-128. [PMID: 30470942 DOI: 10.1007/s10286-018-0582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
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Castellani JW, Yurkevicius BR, Jones ML, Driscoll TJ, Cowell CM, Smith L, Xu X, O'Brien C. Effect of localized microclimate heating on peripheral skin temperatures and manual dexterity during cold exposure. J Appl Physiol (1985) 2018; 125:1498-1510. [PMID: 30138077 DOI: 10.1152/japplphysiol.00513.2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Reduced dexterity is a major problem in cold weather, with a need for a countermeasure that increases hand (Thand) and finger (Tfing) temperatures and improves dexterity. The purpose of this study was to determine whether electric heat (set point, 42°C) applied to the forearm (ARM, 82 W), face (FACE, 9.2 W), or combination of both (COMB, 91.2 W), either at the beginning of cold exposure (COLD; 0.5°C, 120 min; 2 clo insulation, seated, bare-handed) or after Tfing fell to 10.5°C [delayed trials (D)], improves Thand, Tfing, dexterity, and finger key pinch strength (Sfing). Volunteers ( n = 8; 26 ± 9 yr) completed 7 experimental trials in COLD: ARM, ARM-D, FACE, FACE-D, COMB, COMB-D, and no heating (CON). Temperatures were measured before (BASE) and throughout COLD. Tests of dexterity [Purdue Pegboard assembly (PP) and magazine loading (MAGLOAD)] and Sfing were measured at BASE and after 45 and 90 min of COLD. Data presented are at minute 90. Thand was warmer ( P < 0.001) during ARM (18.0 ± 2.6°C) and COMB (18.9 ± 2.0°C) versus CON (15.3 ± 1.5°C) and FACE (15.8 ± 1.5°C) for heating that was initiated at the beginning of COLD. Tfing was higher ( P < 0.04) during COMB (12.7 ± 5.1°C) versus CON (9.7 ± 2.1°C) and FACE (8.9 ± 2.2°C). The change from BASE for PP (no. of pieces) was less ( P < 0.005) in COMB (-4.5 ± 3.3) and ARM (-5.0 ± 6.0) versus CON (-13.0 ± 7.3) and FACE (-10.0 ± 8.3), and for MAGLOAD, it tended ( P = 0.06) to be less in COMB (-8.9 ± 6.2 cartridges) versus CON (-14.8 ± 3.7 cartridges). There was no change in Sfing from BASE (10.5 kg) to minute 90 in ARM or COMB (0.7 ± 1.4 and -0.2 ± 1.7 kg, respectively) but a decrease ( P < 0.01) in CON and FACE (-2.1 ± 2.0 and -1.6 ± 1.9 kg, respectively). There were no differences in Thand, Tfing, dexterity, and Sfing at minute 90 when comparing heating that was initiated at the beginning of COLD versus delayed heating. In conclusion, heating using either COMB or ARM, compared with CON and FACE, improved Thand and Tfing and reduced the decline in dexterity by 20%-50% and Sfing by 90%. Furthermore, delayed heating had no deleterious effect on Thand, Tfing, dexterity, and Sfing compared with heating that started at the beginning of cold exposure. NEW & NOTEWORTHY The present study demonstrated that, during sedentary cold air exposure, localized heating that was applied from the beginning of cold exposure on the forearm increases hand and finger temperatures and finger strength, leading to subsequent improvements in manual dexterity. In addition, localized heating that was delayed until finger temperatures cooled significantly also caused higher peripheral temperatures, leading to better strength and manual dexterity, compared with no heating.
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Affiliation(s)
- John W Castellani
- United States Army Research Institute of Environmental Medicine , Natick, Massachusetts
| | - Beau R Yurkevicius
- United States Army Research Institute of Environmental Medicine , Natick, Massachusetts
| | - Myra L Jones
- United States Army Research Institute of Environmental Medicine , Natick, Massachusetts
| | - Timothy J Driscoll
- United States Army Research Institute of Environmental Medicine , Natick, Massachusetts
| | - Courtney M Cowell
- United States Army Research Institute of Environmental Medicine , Natick, Massachusetts
| | - Laurel Smith
- United States Army Research Institute of Environmental Medicine , Natick, Massachusetts
| | - Xiaojiang Xu
- United States Army Research Institute of Environmental Medicine , Natick, Massachusetts
| | - Catherine O'Brien
- United States Army Research Institute of Environmental Medicine , Natick, Massachusetts
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Eickholt C, Jungen C, Drexel T, Alken F, Kuklik P, Muehlsteff J, Makimoto H, Hoffmann B, Kelm M, Ziegler D, Kloecker N, Willems S, Meyer C. Sympathetic and Parasympathetic Coactivation Induces Perturbed Heart Rate Dynamics in Patients with Paroxysmal Atrial Fibrillation. Med Sci Monit 2018; 24:2164-2172. [PMID: 29641513 PMCID: PMC5910663 DOI: 10.12659/msm.905209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Recent evidence indicates that sympathetic/parasympathetic coactivation (CoA) is causally linked to changes in heart rate (HR) dynamics. Whether this is relevant for patients with atrial fibrillation (AF) is unknown. Material/Methods In patients with paroxysmal AF (n=26) and age-matched controls, (n=10) we investigated basal autonomic outflow and HR dynamics during separate sympathetic (cold hand immersion) and parasympathetic activation (O2-inhalation), as well as during CoA (cold face test). In an additional cohort (n=7), HR response was assessed before and after catheter-based pulmonary vein isolation (PVI). Ultra-high-density endocardial mapping was performed in patients (n=6) before and after CoA. Results Sympathetic activation increased (control: 74±3 vs. 77±3 bpm, p=0.0098; AF: 60±2 vs. 64±2 bpm, p=0.0076) and parasympathetic activation decreased HR (control: 71±3 vs. 69±3 bpm, p=0.0547; AF: 60±1 vs. 58±2 bpm, p<0.0009), while CoA induced a paradoxical HR increase in patients with AF (control: 73±3 vs. 71±3 bpm, p=0.084; AF: 59±2 vs. 61±2 bpm, p=0.0006), which was abolished after PVI. Non-linear parameters of HR variability (SD1) were impaired during coactivation in patients with AF (control: 61±7 vs. 69±6 ms, p=0.042, AF: 44±32 vs. 32±5 ms, p=0.3929). CoA was associated with a shift of the earliest activation site (18±4 mm) of the sinoatrial nodal region, as documented by ultra-high-density mapping (3442±343 points per map). Conclusions CoA perturbs HR dynamics and shifts the site of earliest endocardial activation in patients with paroxysmal AF. This effect is abolished by PVI, supporting the value of emerging methods targeting the intrinsic cardiac autonomic nervous system to treat AF. CoA might be a valuable tool to assess cardiac autonomic function in a clinical setting.
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Affiliation(s)
- Christian Eickholt
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Jungen
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Drexel
- Department of Internal Medicine, Evangelisches Krankenhaus, Duesseldorf, Germany
| | - Fares Alken
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pawel Kuklik
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Muehlsteff
- Philips Research, Patient Care Solutions, Eindhoven, Netherlands
| | - Hisaki Makimoto
- Section for Rhythmology, Department of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Boris Hoffmann
- Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Malte Kelm
- Department of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center and Leibniz Center for Diabetes Research at the Department of Metabolic Diseases, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Nikolaj Kloecker
- Institute for Neural and Sensory Physiology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Stephan Willems
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Meyer
- Department of Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Ikäheimo TM. Cardiovascular diseases, cold exposure and exercise. Temperature (Austin) 2018; 5:123-146. [PMID: 30377633 DOI: 10.1080/23328940.2017.1414014] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 12/11/2022] Open
Abstract
Both acute and prolonged cold exposure affect cardiovascular responses, which may be modified by an underlying cardiovascular disease. In addition, exercise in a cold environment increases cardiovascular strain further, but its effects among persons with cardiovascular diseases are not well known. Controlled studies employing whole-body or local cold exposure demonstrate comparable or augmented increase in cardiac workload, but aggravated cutaneous vasoconstriction in persons with mild hypertension. A strong sympathetic stimulation of a cold pressor test, increases cardiac workload in persons with coronary artery disease (CAD), but does not markedly differ from those with less severe disease or healthy. However, cold exposure reduces myocardial oxygen supply in CAD, which may lead to ischemia. Exercise in cold often augments cardiac workload in persons with CAD more than when performed in thermoneutral conditions. At the same time, reduced myocardial perfusion may lead to earlier ischemia, angina and impaired performance. Also having a heart failure deteriorates submaximal and maximal performance in the cold. Antianginal medication is beneficial in the cold in lowering blood pressure, but does not affect the magnitude of cold-related cardiovascular responses in hypertension. Similarly, the use of blood pressure lowering medication improves exercise performance in cold both among persons with CAD and heart failure. Both the acute and seasonal effects of cold and added with exercise may contribute to the higher morbidity and mortality of those with cardiovascular diseases. Yet, more controlled studies for understanding the pathophysiological mechanisms behind the adverse cold-related health effects are warranted.
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Affiliation(s)
- Tiina M Ikäheimo
- Center For Environmental and Respiratory Health Research, University of Oulu, FI-90014 University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, FI-90029 OYS, Oulu, Finland
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Dietrich P, Dragatsis I. Familial Dysautonomia: Mechanisms and Models. Genet Mol Biol 2016; 39:497-514. [PMID: 27561110 PMCID: PMC5127153 DOI: 10.1590/1678-4685-gmb-2015-0335] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/16/2016] [Indexed: 11/22/2022] Open
Abstract
Hereditary Sensory and Autonomic Neuropathies (HSANs) compose a heterogeneous group of genetic disorders characterized by sensory and autonomic dysfunctions. Familial Dysautonomia (FD), also known as HSAN III, is an autosomal recessive disorder that affects 1/3,600 live births in the Ashkenazi Jewish population. The major features of the disease are already present at birth and are attributed to abnormal development and progressive degeneration of the sensory and autonomic nervous systems. Despite clinical interventions, the disease is inevitably fatal. FD is caused by a point mutation in intron 20 of the IKBKAP gene that results in severe reduction in expression of IKAP, its encoded protein. In vitro and in vivo studies have shown that IKAP is involved in multiple intracellular processes, and suggest that failed target innervation and/or impaired neurotrophic retrograde transport are the primary causes of neuronal cell death in FD. However, FD is far more complex, and appears to affect several other organs and systems in addition to the peripheral nervous system. With the recent generation of mouse models that recapitulate the molecular and pathological features of the disease, it is now possible to further investigate the mechanisms underlying different aspects of the disorder, and to test novel therapeutic strategies.
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Affiliation(s)
- Paula Dietrich
- Department of Physiology, The University of Tennessee, Memphis, TN, USA
| | - Ioannis Dragatsis
- Department of Physiology, The University of Tennessee, Memphis, TN, USA
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Hintsala HE, Kiviniemi AM, Tulppo MP, Helakari H, Rintamäki H, Mäntysaari M, Herzig KH, Keinänen-Kiukaanniemi S, Jaakkola JJK, Ikäheimo TM. Hypertension Does Not Alter the Increase in Cardiac Baroreflex Sensitivity Caused by Moderate Cold Exposure. Front Physiol 2016; 7:204. [PMID: 27313543 PMCID: PMC4889607 DOI: 10.3389/fphys.2016.00204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/19/2016] [Indexed: 11/13/2022] Open
Abstract
Exposure to cold increases blood pressure and may contribute to higher wintertime cardiovascular morbidity and mortality in hypertensive people, but the mechanisms are not well-established. While hypertension does not alter responses of vagally-mediated heart rate variability to cold, it is not known how hypertension modifies baroreflex sensitivity (BRS) and blood pressure variability during cold exposure. Our study assessed this among untreated hypertensive men during short-term exposure comparable to habitual winter time circumstances in subarctic areas. We conducted a population-based recruitment of 24 untreated hypertensive and 17 men without hypertension (age 55–65 years) who underwent a whole-body cold exposure (−10°C, wind 3 m/s, winter clothes, 15 min, standing). Electrocardiogram and continuous blood pressure were measured to compute spectral powers of systolic blood pressure and heart rate variability at low (0.04–0.15 Hz) and high frequency (0.15–0.4 Hz) and spontaneous BRS at low frequency (LF). Comparable increases in BRS were detected in hypertensive men, from 2.6 (2.0, 4.2) to 3.8 (2.5, 5.1) ms/mmHg [median (interquartile range)], and in control group, from 4.3 (2.7, 5.0) to 4.4 (3.1, 7.1) ms/mmHg. Instead, larger increase (p < 0.05) in LF blood pressure variability was observed in control group; response as median (interquartile range): 8 (2, 14) mmHg2, compared with hypertensive group [0 (−13, 20) mmHg2]. Untreated hypertension does not disturb cardiovascular protective mechanisms during moderate cold exposure commonly occurring in everyday life. Blunted response of the estimate of peripheral sympathetic modulation may indicate higher tonic sympathetic activity and decreased sympathetic responsiveness to cold in hypertension.
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Affiliation(s)
- Heidi E Hintsala
- Center for Environmental and Respiratory Health Research (CERH), University of OuluOulu, Finland; Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of OuluOulu, Finland
| | - Antti M Kiviniemi
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of OuluOulu, Finland; Research Unit of Internal Medicine, University of OuluOulu, Finland
| | - Mikko P Tulppo
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of OuluOulu, Finland; Research Unit of Internal Medicine, University of OuluOulu, Finland
| | - Heta Helakari
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu Oulu, Finland
| | - Hannu Rintamäki
- Finnish Institute of Occupational HealthOulu, Finland; Research Unit of Biomedicine, University of OuluOulu, Finland
| | - Matti Mäntysaari
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu Oulu, Finland
| | - Karl-Heinz Herzig
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of OuluOulu, Finland; Research Unit of Biomedicine, University of OuluOulu, Finland; Biocenter of Oulu, University of OuluOulu, Finland; Department of Gastroenterology and Metabolism, Poznan University of Medical SciencesPoznan, Poland
| | - Sirkka Keinänen-Kiukaanniemi
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of OuluOulu, Finland; Center for Life Course Health Research, University of OuluOulu, Finland; Unit of Primary Health Care, Oulu University HospitalOulu, Finland
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research (CERH), University of OuluOulu, Finland; Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of OuluOulu, Finland; Internal Medicine, Oulu University HospitalOulu, Finland
| | - Tiina M Ikäheimo
- Center for Environmental and Respiratory Health Research (CERH), University of OuluOulu, Finland; Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of OuluOulu, Finland
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11
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Diurnal variation in the diving bradycardia response in young men. Clin Auton Res 2016; 26:135-40. [PMID: 26795189 DOI: 10.1007/s10286-016-0342-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The present study aimed to examine diurnal variation of the diving bradycardia responses on the same day. METHODS Eighteen young men (age 26 ± 2 years; height 174.2 ± 6.0 cm; body mass 70.2 ± 8.1 kg; body fat 18.0 ± 3.8 %; mean ± standard deviation) participated in this study. Oral temperature, heart rate variability (HRV) from 5-min of electrocardiogram data, and diving bradycardia responses were measured at 0900, 1300, and 1700 hours daily. All participants performed diving reflex tests twice in the sitting position with the face immersed in cold water (1.9-3.1 °C) and apnea at midinspiration for a minimum of 30 s and as long as possible, in consecutive order. RESULTS Oral temperature was found to be less in the morning (0900) than in the afternoon (1300) and evening (1700). In the frequency domain parameters of heart rate variability, the natural logarithms of high-frequency power were higher in the morning than in the evening. All participants showed bradycardia response to the two diving reflex tests. The peak values of R-R interval during the diving reflex test both for as long as possible and 30 s were longer in the morning than in the afternoon and evening. CONCLUSION Our results indicated that the maximal bradycardia during the diving reflex test exhibits a diurnal variation, with peak levels at morning and gradual decrease towards the evening. The HRV indexes show the same variation.
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Chalacheva P, Kato RM, Sangkatumvong S, Detterich J, Bush A, Wood JC, Meiselman H, Coates TD, Khoo MCK. Autonomic responses to cold face stimulation in sickle cell disease: a time-varying model analysis. Physiol Rep 2015; 3:3/7/e12463. [PMID: 26177958 PMCID: PMC4552538 DOI: 10.14814/phy2.12463] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 11/24/2022] Open
Abstract
Sickle cell disease (SCD) is characterized by sudden onset of painful vaso-occlusive crises (VOC), which occur on top of the underlying chronic blood disorder. The mechanisms that trigger VOC remain elusive, but recent work suggests that autonomic dysfunction may be an important predisposing factor. Heart-rate variability has been employed in previous studies, but the derived indices have provided only limited univariate information about autonomic cardiovascular control in SCD. To circumvent this limitation, a time-varying modeling approach was applied to investigate the functional mechanisms relating blood pressure (BP) and respiration to heart rate and peripheral vascular resistance in healthy controls, untreated SCD subjects and SCD subjects undergoing chronic transfusion therapy. Measurements of respiration, heart rate, continuous noninvasive BP and peripheral vascular resistance were made before, during and after the application of cold face stimulation (CFS), which perturbs both the parasympathetic and sympathetic nervous systems. Cardiac baroreflex sensitivity estimated from the model was found to be impaired in nontransfused SCD subjects, but partially restored in SCD subjects undergoing transfusion therapy. Respiratory-cardiac coupling gain was decreased in SCD and remained unchanged by chronic transfusion. These results are consistent with autonomic dysfunction in the form of impaired parasympathetic control and sympathetic overactivity. As well, CFS led to a significant reduction in vascular resistance baroreflex sensitivity in the nontransfused SCD subjects but not in the other groups. This blunting of the baroreflex control of peripheral vascular resistance during elevated sympathetic drive could be a potential factor contributing to the triggering of VOC in SCD.
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Affiliation(s)
- Patjanaporn Chalacheva
- Department of Biomedical Engineering, Viterbi School of Engineering University of Southern California, Los Angeles, California, USA
| | - Roberta M Kato
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Suvimol Sangkatumvong
- Department of Biomedical Engineering, Viterbi School of Engineering University of Southern California, Los Angeles, California, USA
| | - Jon Detterich
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Adam Bush
- Department of Biomedical Engineering, Viterbi School of Engineering University of Southern California, Los Angeles, California, USA
| | - John C Wood
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Herbert Meiselman
- Department of Physiology and Biophysics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Thomas D Coates
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Michael C K Khoo
- Department of Biomedical Engineering, Viterbi School of Engineering University of Southern California, Los Angeles, California, USA
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13
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Wieske L, Kiszer ER, Schultz MJ, Verhamme C, van Schaik IN, Horn J. Examination of cardiovascular and peripheral autonomic function in the ICU: a pilot study. J Neurol 2012; 260:1511-7. [PMID: 23275003 DOI: 10.1007/s00415-012-6818-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 12/17/2012] [Accepted: 12/19/2012] [Indexed: 12/19/2022]
Abstract
UNLABELLED Critical illness may affect the autonomic nervous system. Decreased cardiovascular autonomic function measured by heart rate variability (HRV) has been reported in critically ill patients but limited information exists about other autonomic functions. The cold face test (CFT) and skin wrinkle test (SWT) have never been investigated in critically ill patients. Feasibility and safety of the CFT and SWT were investigated in critically ill patients. EXCLUSION CRITERIA polyneuropathy, autonomic neuropathy, admission after stroke, spinal cord injury or cardiac arrest. For the CFT, a cold pack was applied to the forehead to measure the maximal increase in RR interval. The simulated SWT was used and wrinkling was assessed on a five-point scale. HRV was investigated using power spectral analysis of continuous 5-min ECG recordings. Twelve critically ill patients were included (mean age 54). No adverse effects for the CFT and SWT were noted. The CFT could be performed in 10 patients and showed an abnormal response in 9. The SWT could be performed in 11 patients; results were abnormal in 6. HRV analysis showed decreased HRV in all patients. CFT and HRV responses were correlated with each other, no correlation was found between SWT and CFT or HRV results. The CFT and SWT are feasible and safe in critically ill patients. Cardiovascular dysfunction may be more prevalent in critical illness than peripheral sympathetic dysfunction. Influence of confounders and further validation of these tests needs to be investigated.
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Affiliation(s)
- L Wieske
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, room G3-228, PO box 22700, 1105 AZ, Amsterdam, The Netherlands.
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14
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Okamoto-Mizuno K, Mizuno K. Effects of thermal environment on sleep and circadian rhythm. J Physiol Anthropol 2012; 31:14. [PMID: 22738673 PMCID: PMC3427038 DOI: 10.1186/1880-6805-31-14] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 05/31/2012] [Indexed: 01/04/2023] Open
Abstract
The thermal environment is one of the most important factors that can affect human sleep. The stereotypical effects of heat or cold exposure are increased wakefulness and decreased rapid eye movement sleep and slow wave sleep. These effects of the thermal environment on sleep stages are strongly linked to thermoregulation, which affects the mechanism regulating sleep. The effects on sleep stages also differ depending on the use of bedding and/or clothing. In semi-nude subjects, sleep stages are more affected by cold exposure than heat exposure. In real-life situations where bedding and clothing are used, heat exposure increases wakefulness and decreases slow wave sleep and rapid eye movement sleep. Humid heat exposure further increases thermal load during sleep and affects sleep stages and thermoregulation. On the other hand, cold exposure does not affect sleep stages, though the use of beddings and clothing during sleep is critical in supporting thermoregulation and sleep in cold exposure. However, cold exposure affects cardiac autonomic response during sleep without affecting sleep stages and subjective sensations. These results indicate that the impact of cold exposure may be greater than that of heat exposure in real-life situations; thus, further studies are warranted that consider the effect of cold exposure on sleep and other physiological parameters.
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Affiliation(s)
- Kazue Okamoto-Mizuno
- Kansei Fukushi Research Center, Tohoku Fukushi University, 1-149-6 Kunimigaoka Aoba Sendai, Miyagi, 981-0935, Japan.
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15
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Okamoto-Mizuno K, Tsuzuki K, Mizuno K, Ohshiro Y. Effects of low ambient temperature on heart rate variability during sleep in humans. Eur J Appl Physiol 2008; 105:191-7. [PMID: 19015871 DOI: 10.1007/s00421-008-0889-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2008] [Indexed: 11/25/2022]
Abstract
The effects of cold exposure on heart rate variability (HRV) during sleep were examined. Eight male subjects slept under three different conditions: 3 degrees C, 50-80% relative humidity (RH) [3]; 10 degrees C, 50% RH [10]; and 17 degrees C 50% RH [17]. No significant differences were observed in HRV during rapid eye movement sleep (REM) and wakefulness. The ratio of the low frequency (LF) to high frequency component (HF) of HRV (LF/HF) significantly differed among the conditions during stage 2 and slow wave sleep (SWS) that decreased as the ambient temperature decreased. The normalized LF [LF/(LF + HF)] significantly decreased in 3 and 10 than in 17 during SWS. In low ambient temperature, predominant cardiac parasympathetic activity during stage 2 with no significant difference during REM and wakefulness may cause variations in HRV at transition from stage 2 to REM and wakefulness. These results may partly explain the peak in adverse cardiac events during winter.
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Affiliation(s)
- Kazue Okamoto-Mizuno
- National Institute of Advanced Industrial Science and Technology, AIST Tsukuba Central 6, 1-1-1, Higashi, Tsukuba, Ibaraki 305-8566, Japan.
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16
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Rubin BY, Anderson SL. The molecular basis of familial dysautonomia: overview, new discoveries and implications for directed therapies. Neuromolecular Med 2007; 10:148-56. [PMID: 17985250 DOI: 10.1007/s12017-007-8019-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Accepted: 10/17/2007] [Indexed: 01/05/2023]
Abstract
Familial dysautonomia (FD) is a sensory and autonomic neuropathy that affects the development and survival of sensory, sympathetic, and some parasympathetic neurons. It is autosomally inherited and occurs almost exclusively among individuals of Ashkenazi Jewish descent. The pathological and clinical manifestations of FD have been extensively studied and therapeutic modalities have, until recently, focused primarily on addressing the symptoms experienced by those with this fatal disorder. The primary FD-causing mutation is an intronic nucleotide substitution that alters the splicing of the IKBKAP-derived transcript. Recent efforts have resulted in the development of new therapeutic modalities that facilitate the increased production of the correctly spliced transcript and mitigate the symptoms of those with FD. Furthermore, the recent demonstration of the reduced presence of monoamine oxidase A in cells and tissues of individuals with FD has provided new insight into the cause of hypertensive crises experienced by these patients.
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Affiliation(s)
- Berish Y Rubin
- Department of Biological Sciences, Laboratory for Familial Dysautonomia Research, Fordham University, 441 East Fordham Road, Bronx, NY 10458, USA.
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17
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Abstract
The cold face test (CFT) evokes reflex bradycardia and pressor responses. Bradycardia has been used to assess vagal function. This study evaluated two aspects of physiology and clinical applicability of the pressor response. During constant monitoring of blood pressure (Finapres) and heart rate (EKG), CFT was induced by the application of three cold packs (0.5 degrees C) to the face for 1 min. Group 1: Latencies of systolic blood pressure (SBP) and heart rate (HR) response to the CFT were recorded in 10 normal subjects. Group 2: CFT was performed in eight normal subjects after cholinergic blockade with atropine (0.03 mg/kg body weight intravenously). Group 3: Four patients with baroreflex failure and five patients with pure autonomic failure were subjected to CFT. In Group 1, mean latency of CFT-induced SBP rise (mean +/- SD) (13.8 +/- 16.6 s) was longer than that of bradycardia (5.6 +/- 4.6 s). In Group 2, bradycardia was abolished in all subjects and SBP was unaffected after atropine administration. In Group 3, patients with baroreflex failure demonstrated normal HR and SBP responses to CFT. In the pure autonomic failure patients, bradycardia was absent and SBP response was either absent or subnormal. The adrenergic phase of the CFT is independent of the cholinergic phase (bradycardia) and baroreceptors. Rise in SBP is useful in evaluating the integrity of the efferent sympathetic pathway with baroreflex failure. Absence of SBP rise in response to the CFT may be of diagnostic value in detecting the sympathetic component of pure autonomic failure.
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Affiliation(s)
- Ramesh K Khurana
- The Union Memorial Hospital, 201 East University Parkway, Room 411, 33rd Street Building, Baltimore, MD 21218, USA.
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18
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Dütsch M, Devinsky O, Doyle W, Marthol H, Hilz MJ. Cerebral autoregulation improves in epilepsy patients after temporal lobe surgery. J Neurol 2005; 251:1190-7. [PMID: 15503096 DOI: 10.1007/s00415-004-0501-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2003] [Revised: 03/24/2004] [Accepted: 03/26/2004] [Indexed: 10/26/2022]
Abstract
Patients with temporal lobe epilepsy (TLE) often show increased cardiovascular sympathetic modulation during the interictal period, that decreases after epilepsy surgery. In this study, we evaluated whether temporal lobectomy changes autonomic modulation of cerebral blood flow velocity (CBFV) and cerebral autoregulation. We studied 16 TLE patients 3-4 months before and after surgery. We monitored heart rate (HR), blood pressure (BP), respiration, transcutaneous oxygen saturation (sat-O(2)), end-expiratory carbon dioxide partial pressure (pCO(2)) and middle cerebral artery CBFV. Spectral analysis was used to determine sympathetic and parasympathetic modulation of HR, BP and CBFV as powers of signal oscillations in the low frequency (LF) ranges from 0.04-0.15Hz (LF-power) and in the high frequency ranges from (HF) 0.15-0.5Hz (HF-power). LF-transfer function gain and phase shift between BP and CBFV were calculated as parameters of cerebral autoregulation. After surgery, HR, BP(mean), CBFV(mean), respiration, sat-O(2), pCO(2) and HF powers remained unchanged. LF-powers of HR, BP, CBFV and LF-transfer function gain had decreased while the phase angle had increased (p<0.05). The reduction of LF powers and LF-gain and the higher phase angle showed reduced sympathetic modulation and improved cerebral autoregulation. The enhanced cerebrovascular stability after surgery may improve autonomic balance in epilepsy patients.
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Affiliation(s)
- Matthias Dütsch
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
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Journeay WS, Reardon FD, Kenny GP. Cardiovascular responses to apneic facial immersion during altered cardiac filling. J Appl Physiol (1985) 2003; 94:2249-54. [PMID: 12598488 DOI: 10.1152/japplphysiol.01140.2002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The hypothesis that reduced cardiac filling, as a result of lower body negative pressure (LBNP) and postexercise hypotension (PEH), would attenuate the reflex changes to heart rate (HR), skin blood flow (SkBF), and mean arterial pressure (MAP) normally induced by facial immersion was tested. The purpose of this study was to investigate the cardiovascular control mechanisms associated with apneic facial immersion during different cardiovascular challenges. Six subjects randomly performed 30-s apneic facial immersions in 6.0 +/- 1.2 degrees C water under the following conditions: 1) -20 mmHg LBNP, 2) +40 mmHg lower body positive pressure (LBPP), 3) during a period of PEH, and 4) normal resting (control). Measurements included SkBF at one acral (distal phalanx of the thumb) and one nonacral region of skin (ventral forearm), HR, and MAP. Facial immersion reduced HR and SkBF at both sites and increased MAP under all conditions (P < 0.05). Reduced cardiac filling during LBNP and PEH significantly attenuated the absolute HR nadir observed during the control immersion (P < 0.05). The LBPP condition did not result in a lower HR nadir than control but did result in a nadir significantly lower than that of the LBNP and PEH conditions (P < 0.05). No differences were observed in either SkBF or MAP between conditions; however, the magnitude of SkBF reduction was greater at the acral site than at the nonacral site for all conditions (P < 0.05). These results suggest that the cardiac parasympathetic response during facial immersion can be attenuated when cardiac filling is compromised.
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Affiliation(s)
- W Shane Journeay
- Human Performance and Environmental Medicine Research Laboratory, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada K1N 6N5
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Hilz MJ, Devinsky O, Doyle W, Mauerer A, Dütsch M. Decrease of sympathetic cardiovascular modulation after temporal lobe epilepsy surgery. Brain 2002; 125:985-95. [PMID: 11960889 DOI: 10.1093/brain/awf092] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In temporal lobe epilepsy (TLE), there is evidence of ictal and interictal autonomic dysregulation, predominantly with sympathetic overactivity. The effects of TLE surgery on autonomic cardiovascular control and on baroreflex sensitivity (BRS) have not been studied. To evaluate such effects, we monitored heart rate (HR), systolic blood pressure (BP(sys)) and respiration in 18 TLE patients 3-4 months before and after TLE surgery. We used Blackman-Tukey spectral analysis to assess sympathetic and parasympathetic modulation as powers of HR and BP(sys) oscillations in the low frequency (LF, 0.04-0.15 Hz) and high frequency (HF, 0.15-0.5 Hz) bands. BRS was determined as the LF transfer function gain between BP and HR. After surgery, HR, BP(sys), respiration and HF powers remained unchanged, while LF powers of HR (1.57 +/- 1.54 bpm(2)) and BP(sys) (2.19 +/- 1.34 mmHg(2)) and BRS (0.68 +/- 0.31 bpm/mmHg) were smaller than pre-surgical LF powers of HR (3.87 +/- 3.26 bpm(2)) and BP(sys) (4.80 +/- 3.84 mmHg(2)) and BRS (1.12 +/- 0.39 bpm/mmHg; P < 0.05). After TLE surgery, there is a reduction of sympathetic cardiovascular modulation and BRS that might result from decreased influences of interictal epileptogenic discharges on brain areas involved in cardiovascular autonomic control. TLE surgery seems to stabilize the cardiovascular control in epilepsy patients by reducing the risk of sympathetically mediated tachyarrhythmias and excessive bradycardiac counter-regulation, both of which might be relevant for the pathophysiology of sudden unexpected death in epilepsy patients (SUDEP). Thus, TLE surgery might contribute to reducing the risk of SUDEP.
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Affiliation(s)
- M J Hilz
- Department of Neurology, New York University, New York, NY, USA.
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