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Dorey TW, Nightingale TE, Alrashidi AA, Thomas S, Currie KD, Hubli M, Balthazaar SJT, Krassioukov AV. Effects of exercise on autonomic cardiovascular control in individuals with chronic, motor-complete spinal cord injury: an exploratory randomised clinical trial. Spinal Cord 2024; 62:597-604. [PMID: 39217247 DOI: 10.1038/s41393-024-01019-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/12/2024] [Accepted: 07/18/2024] [Indexed: 09/04/2024]
Abstract
STUDY DESIGN Secondary analysis of a clinical trial. OBJECTIVE To assess the impact of 6 months of arm cycle ergometry training (ACET), or body weight-supported treadmill training (BWSTT), on autonomic cardiovascular responses to a laboratory sit-up test (SUT) in individuals with chronic (≥1-year post-injury) spinal cord injury (SCI). SETTING Tertiary Rehabilitation Centre, Vancouver, Canada. METHODS Sixteen individuals with motor-complete (American Spinal Injury Association Impairment Scale A-B) SCI between the fourth cervical and sixth thoracic spinal cord segments, aged 39 ± 11 years, were assessed. Participants were randomized to receive 72 sessions of moderate-to-vigorous intensity ACET (n = 8) or passive BWSTT (n = 8). Changes in mean arterial pressure (finger plethysmography), hemodynamics (Modelflow® method), and heart rate/heart rate variability (HR/HRV; electrocardiography) were measured in response to a SUT before and after 6 months of exercise training. Spontaneous cardiovagal baroreflex sensitivity (cvBRS) was assessed using the sequence method. RESULTS Neither ACET nor BWSTT impacted hemodynamic responses to SUT or the incidence of orthostatic hypotension (all P > 0.36). ACET increased HR (P < 0.01, ηp2 = 0.34) and high frequency (HF) power HRV responses (P < 0.01, ηp2 = 0.42) to SUT following 6 months of training while BWSTT did not. Consistent with this, cvBRS improved (P < 0.05, ηp2 = 0.16) only following ACET. Improvements in cvBRS were correlated with both the HR (r = 0.726, P < 0.0001) and HF power (r = -0.484, P < 0.01) responses to SUT. CONCLUSION Six months of ACET, but not BWSTT, improved cardiovagal baroreflex control of HR but had no effect on BP responses to SUT in individuals with chronic, motor-complete SCI. SPONSORSHIP Canadian Institutes of Health Research (CIHR) CLINICAL TRIAL REGISTRATION: NCT01718977.
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Affiliation(s)
- Tristan W Dorey
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tom E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Abdullah A Alrashidi
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
- King Fahad Medical City, Physical Therapy Department, Riyadh, Saudi Arabia
| | - Stefan Thomas
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Katharine D Currie
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Shane J T Balthazaar
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Cardiology, University of British Columbia, Vancouver General & University of British Columbia Hospital Echocardiography Department, Vancouver, BC, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.
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Salah HM, Gupta R, Hicks AJ, Mahmood K, Haglund NA, Bindra AS, Antoine SM, Garcia R, Yehya A, Yaranov DM, Patel PP, Feliberti JP, Rollins AT, Rao VN, Letarte L, Raje V, Alam AH, McCann P, Raval NY, Howard B, Fudim M. Baroreflex Function in Cardiovascular Disease. J Card Fail 2024:S1071-9164(24)00415-9. [PMID: 39341547 DOI: 10.1016/j.cardfail.2024.08.062] [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: 04/01/2024] [Revised: 07/26/2024] [Accepted: 08/10/2024] [Indexed: 10/01/2024]
Abstract
The baroreflex system is involved in modulating several physiological functions of the cardiovascular system and can directly and indirectly modulate cardiac output, blood pressure, and cardiac electrophysiology. In addition, it is involved in regulating neurohormonal pathways involved in the cardiovascular function, such as the renin-angiotensin-aldosterone system (RAAS) and vasopressin release. Baroreflex dysfunction is characterized by sympathetic overactivation and parasympathetic withdrawal and is associated with several cardiovascular diseases, such as hypertension, heart failure (HF), and coronary artery disease (CAD). Targeting the baroreflex system via invasive (e.g., baroreflex activation therapy and endovascular baroreceptor amplification) and non-invasive approaches (e.g., slow breathing exercises and exercise training) has emerged as a novel pathway to manage cardiovascular diseases. Studies examining the long-term safety and efficacy of such interventions in various cardiovascular diseases are needed.
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Affiliation(s)
- Husam M Salah
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Richa Gupta
- MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Advanced Heart Failure Program, Georgetown University School of Medicine, Washington, DC
| | - Albert J Hicks
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Kiran Mahmood
- Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicholas A Haglund
- Minneapolis Heart Institute, Allina Health at Abbott Northwestern Hospital, Minneapolis, MN
| | | | - Steve M Antoine
- Michael E DeBakey Veterans Affairs Hospital and Baylor College of Medicine, Center for Cardiovascular Disease Prevention, Houston, Texas
| | - Rachel Garcia
- Atrium Health Sanger Heart & Vascular Institute, Charlotte, NC
| | - Amin Yehya
- Sentara Advanced Heart Failure Center, Norfolk, VA, USA
| | - Dmitry M Yaranov
- Department of Cardiology, Baptist Memorial Hospital, Memphis, Tennessee
| | | | - Jason P Feliberti
- University of South Florida Heart and Vascular Institute, Transplant Cardiology, Tampa, Florida
| | - Allman T Rollins
- Advanced Heart Failure, Inova Schar Heart and Vascular, Falls Church, VA
| | - Vishal N Rao
- Dvision of Cardiology, Medical University of South Carolina, Charleston, SC
| | | | | | - Amit H Alam
- New York University Grossman School of Medicine, New York University Langone Health, New York, New York
| | | | | | | | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
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Gelpi F, Wu MA, Bari V, Cairo B, De Maria B, Fossali T, Colombo R, Porta A. Autonomic Function and Baroreflex Control in COVID-19 Patients Admitted to the Intensive Care Unit. J Clin Med 2024; 13:2228. [PMID: 38673501 PMCID: PMC11050480 DOI: 10.3390/jcm13082228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Autonomic function and baroreflex control might influence the survival rate of coronavirus disease 2019 (COVID-19) patients admitted to the intensive care unit (ICU) compared to respiratory failure patients without COVID-19 (non-COVID-19). This study describes physiological control mechanisms in critically ill COVID-19 patients admitted to the ICU in comparison to non-COVID-19 individuals with the aim of improving stratification of mortality risk. Methods: We evaluated autonomic and baroreflex control markers extracted from heart period (HP) and systolic arterial pressure (SAP) variability acquired at rest in the supine position (REST) and during a modified head-up tilt (MHUT) in 17 COVID-19 patients (age: 63 ± 10 years, 14 men) and 33 non-COVID-19 patients (age: 60 ± 12 years, 23 men) during their ICU stays. Patients were categorized as survivors (SURVs) or non-survivors (non-SURVs). Results: We found that COVID-19 and non-COVID-19 populations exhibited similar vagal and sympathetic control markers; however, non-COVID-19 individuals featured a smaller baroreflex sensitivity and an unexpected reduction in the HP-SAP association during the MHUT compared to the COVID-19 group. Nevertheless, none of the markers of the autonomic and baroreflex functions could distinguish SURVs from non-SURVs in either population. Conclusions: We concluded that COVID-19 patients exhibited a more preserved baroreflex control compared to non-COVID-19 individuals, even though this information is ineffective in stratifying mortality risk.
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Affiliation(s)
- Francesca Gelpi
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (F.G.); (B.C.); (A.P.)
| | - Maddalena Alessandra Wu
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy;
- Division of Internal Medicine, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Vlasta Bari
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (F.G.); (B.C.); (A.P.)
- Department of Cardiothoracic, Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (F.G.); (B.C.); (A.P.)
| | | | - Tommaso Fossali
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (T.F.); (R.C.)
| | - Riccardo Colombo
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (T.F.); (R.C.)
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (F.G.); (B.C.); (A.P.)
- Department of Cardiothoracic, Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 Milan, Italy
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Pichot V, Corbier C, Chouchou F, Barthélémy JC, Roche F. CVRanalysis: a free software for analyzing cardiac, vascular and respiratory interactions. Front Physiol 2024; 14:1224440. [PMID: 38250656 PMCID: PMC10797906 DOI: 10.3389/fphys.2023.1224440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction: Simultaneous beat-to-beat R-R intervals, blood pressure and respiration signals are routinely analyzed for the evaluation of autonomic cardiovascular and cardiorespiratory regulations for research or clinical purposes. The more recognized analyses are i) heart rate variability and cardiac coherence, which provides an evaluation of autonomic nervous system activity and more particularly parasympathetic and sympathetic autonomic arms; ii) blood pressure variability which is mainly linked to sympathetic modulation and myogenic vascular function; iii) baroreflex sensitivity; iv) time-frequency analyses to identify fast modifications of autonomic activity; and more recently, v) time and frequency domain Granger causality analyses were introduced for assessing bidirectional causal links between each considered signal, thus allowing the scrutiny of many physiological regulatory mechanisms. Methods: These analyses are commonly applied in various populations and conditions, including mortality and morbidity predictions, cardiac and respiratory rehabilitation, training and overtraining, diabetes, autonomic status of newborns, anesthesia, or neurophysiological studies. Results: We developed CVRanalysis, a free software to analyze cardiac, vascular and respiratory interactions, with a friendly graphical interface designed to meet laboratory requirements. The main strength of CVRanalysis resides in its wide scope of applications: recordings can arise from beat-to-beat preprocessed data (R-R, systolic, diastolic and mean blood pressure, respiration) or raw data (ECG, continuous blood pressure and respiratory waveforms). It has several tools for beat detection and correction, as well as setting of specific areas or events. In addition to the wide possibility of analyses cited above, the interface is also designed for easy study of large cohorts, including batch mode signal processing to avoid running repetitive operations. Results are displayed as figures or saved in text files that are easily employable in statistical softwares. Conclusion: CVRanalysis is freely available at this website: anslabtools.univ-st-etienne.fr. It has been developed using MATLAB® and works on Windows 64-bit operating systems. The software is a standalone application avoiding to have programming skills and to install MATLAB. The aims of this paper area are to describe the physiological, research and clinical contexts of CVRanalysis, to introduce the methodological approach of the different techniques used, and to show an overview of the software with the aid of screenshots.
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Affiliation(s)
- Vincent Pichot
- SAINBIOSE U1059, Inserm, Saint-Etienne Jean-Monnet University, Clinical Physiology and Exercise, CHU of Saint-Etienne, Saint-Etienne, France
| | - Christophe Corbier
- LASPI EA3059, Saint-Etienne Jean-Monnet University, Roanne Technology University Institute, Roanne, France
| | - Florian Chouchou
- IRISSE EA4075, UFR SHE, University of La Réunion, Le Tampon, France
| | - Jean-Claude Barthélémy
- SAINBIOSE U1059, Inserm, Saint-Etienne Jean-Monnet University, Clinical Physiology and Exercise, CHU of Saint-Etienne, Saint-Etienne, France
| | - Frédéric Roche
- SAINBIOSE U1059, Inserm, Saint-Etienne Jean-Monnet University, Clinical Physiology and Exercise, CHU of Saint-Etienne, Saint-Etienne, France
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Schumann A, Gupta Y, Gerstorf D, Demuth I, Bär KJ. Sex differences in the age-related decrease of spontaneous baroreflex function in healthy individuals. Am J Physiol Heart Circ Physiol 2024; 326:H158-H165. [PMID: 37947436 DOI: 10.1152/ajpheart.00648.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/12/2023]
Abstract
The baroreflex is a powerful physiological mechanism for rapidly adjusting heart rate in response to changes in blood pressure. Spontaneous baroreflex sensitivity (BRS) has been shown to decrease with age. However, studies of sex differences in these age-related changes are rare. Here we investigated several markers of spontaneous baroreflex function in a large sample of healthy individuals. Cardiovascular signals were recorded in the supine position under carefully controlled resting conditions. After quality control, n = 980 subjects were divided into five age groups [age < 30 yr (n = 612), 30-39 yr (n = 140), 40-49 yr (n = 95), 50-59 yr (n = 61), and >60 yr (n = 72)]. Spontaneous baroreflex function was assessed in the time domain (bradycardic and tachycardic slope) and in the frequency domain in the low- and high-frequency band (LF-α, HF-α) applying the transfer function. General linear models showed a significant effect of factor age (P < 0.001) and an age × sex interaction effect (P < 0.05) on each indicator of the baroreflex function. Simple main effects showed a significantly higher BRS as indicated by tachycardic slope, LF-α and HF-α in middle-aged women compared with men (30-39 yr) and higher LF-α, bradycardic and tachycardic slope in men compared with women of the oldest age group (>60 yr). Changes in BRS over the lifespan suggest that baroreflex function declines more slowly but earlier in life in men than in women. Our findings could be linked to age-related changes in major sex hormone levels, suggesting significant implications for diverse cardiovascular outcomes and the implementation of targeted preventive strategies.NEW & NOTEWORTHY In this study, we demonstrate that the age-related decrease of spontaneous baroreflex sensitivity is different in men and women by analyzing resting state cardiovascular data of a large sample of healthy individuals.
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Affiliation(s)
- Andy Schumann
- Lab for Autonomic Neuroscience, Imaging and Cognition, Department for Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Yubraj Gupta
- Lab for Autonomic Neuroscience, Imaging and Cognition, Department for Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Denis Gerstorf
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ilja Demuth
- Department of Endocrinology and Metabolic Diseases, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karl-Jürgen Bär
- Lab for Autonomic Neuroscience, Imaging and Cognition, Department for Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
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De Maria B, Dalla Vecchia LA, Bari V, Cairo B, Gelpi F, Perego F, Takahashi ACM, Milan-Mattos JC, Minatel V, Rehder-Santos P, Esler M, Lambert E, Baumert M, Catai AM, Porta A. The degree of engagement of cardiac and sympathetic arms of the baroreflex does not depend on the absolute value and sign of arterial pressure variations. Physiol Meas 2023; 44:114002. [PMID: 37922536 DOI: 10.1088/1361-6579/ad0976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/03/2023] [Indexed: 11/07/2023]
Abstract
Objective.The percentages of cardiac and sympathetic baroreflex patterns detected via baroreflex sequence (SEQ) technique from spontaneous variability of heart period (HP) and systolic arterial pressure (SAP) and of muscle nerve sympathetic activity (MSNA) burst rate and diastolic arterial pressure (DAP) are utilized to assess the level of the baroreflex engagement. The cardiac baroreflex patterns can be distinguished in those featuring both HP and SAP increases (cSEQ++) and decreases (cSEQ--), while the sympathetic baroreflex patterns in those featuring a MSNA burst rate decrease and a DAP increase (sSEQ+-) and vice versa (sSEQ-+). The present study aims to assess the modifications of the involvement of the cardiac and sympathetic arms of the baroreflex with age and postural stimulus intensity.Approach.We monitored the percentages of cSEQ++ (%cSEQ++) and cSEQ-- (%cSEQ--) in 100 healthy subjects (age: 21-70 years, 54 males, 46 females), divided into five sex-balanced groups consisting of 20 subjects in each decade at rest in supine position and during active standing (STAND). We evaluated %cSEQ++, %cSEQ--, and the percentages of sSEQ+- (%sSEQ+-) and sSEQ-+ (%sSEQ-+) in 12 young healthy subjects (age 23 ± 2 years, 3 females, 9 males) undergoing incremental head-up tilt.Main results.We found that: (i) %cSEQ++ and %cSEQ-- decreased with age and increased with STAND and postural stimulus intensity; (ii) %sSEQ+- and %sSEQ-+ augmented with postural challenge magnitude; (iii) the level of cardiac and sympathetic baroreflex engagement did not depend on either the absolute value of arterial pressure or the direction of its changes.Significance.This study stresses the limited ability of the cardiac and sympathetic arms of the baroreflex in controlling absolute arterial pressure values and the equivalent ability of both positive and negative arterial pressure changes in soliciting them.
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Affiliation(s)
| | | | - Vlasta Bari
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Francesca Gelpi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | | | - Vinicius Minatel
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | - Murray Esler
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Elisabeth Lambert
- School of Health Science, Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Australia
| | - Mathias Baumert
- Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, Australia
| | - Aparecida Maria Catai
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Sibrecht G, Piskorski J, Krauze T, Guzik P. Heart Rate Asymmetry, Its Compensation, and Heart Rate Variability in Healthy Adults during 48-h Holter ECG Recordings. J Clin Med 2023; 12:jcm12031219. [PMID: 36769867 PMCID: PMC9917705 DOI: 10.3390/jcm12031219] [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: 12/28/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Heart rate asymmetry (HRA) reflects different contributions of heart rate (HR) decelerations and accelerations to heart rate variability (HRV). In this study, we examined various properties of HRA, including its compensation and HRV, in 48-h electrocardiogram (ECG) recordings in healthy adults. Furthermore, we compared sex differences in parameters used to quantify HRA and HRV. Variance-based and relative HRA and HRV parameters were computed for Holter ECG recordings lasting up to 48 h in 101 healthy volunteers. The median age of the subjects was 39 years, with 47 of them being men. The prevalence of all forms of HRA was statistically different from randomness (p < 0.0001). Specifically, HR decelerations contributed >50% (C1d) to short-term HRA in 98.02% of subjects, while HR decelerations contributed <50% to long-term HRA in 89.11% of recordings and to total HRA in 88.12% of recordings. Additionally, decelerations accounted for <50% of all changing heartbeats (Porta's index) in 74.26% of subjects, and HRA compensation was present in 88.12% of volunteers. Our findings suggest that various HRA features are present in most healthy adults. While men had more pronounced HRA expression, the prevalence of short-, long-term, and total HRA and its compensation was similar in both sexes. For HRV, values of variance-based indices were higher in men than in women, but no differences were found for relative measures. In conclusion, our study references HRA and HRV for longer ECG recordings of up to 48 h, which have become increasingly important in clinical ECG monitoring. The findings can help understand and compare the characteristics of HRA and HRV in patients with different diseases.
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Affiliation(s)
- Greta Sibrecht
- Department of Cardiology–Intensive Therapy, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland
| | - Jarosław Piskorski
- Institute of Physics, University of Zielona Gora, Szafrana 4a, 65-516 Zielona Gora, Poland
| | - Tomasz Krauze
- Department of Cardiology–Intensive Therapy, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland
| | - Przemysław Guzik
- Department of Cardiology–Intensive Therapy, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland
- Correspondence:
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Zalas D, Bobkowski W, Piskorski J, Guzik P. Heart Rate Asymmetry in Healthy Children. J Clin Med 2023; 12:jcm12031194. [PMID: 36769841 PMCID: PMC9918166 DOI: 10.3390/jcm12031194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Heart rate asymmetry (HRA) is a physiological phenomenon characterized by an unequal contribution of heart rate decelerations and accelerations to different heart rate variability (HRV) features. While HRA has been demonstrated in adults' ECGs of different duration, a similar investigation in healthy children has not been conducted. This study investigated the variance- and number-based HRA features in 96 healthy children (50 girls and 46 boys, aged 3-18 years) using 24-h ECGs. Additionally, we studied sex differences in HRA. To quantify HRA, variance-based and relative contributions of heart rate decelerations to short-term (C1d), long-term (C2d), and total (CTd) HRV, and the number of all heartbeats (Nd) were computed. Heart rate decelerations contributed more to C1d, but less to C2d and CTd, and were less frequent than heart rate accelerations. Short-term HRA was better expressed in boys. The majority of children (93.7%) had short-term HRA, 88.5% had long-term HRA, 88.5% had total HRA, and 99.0% had more accelerations than decelerations. No sex differences were observed for the rate of various HRA features. Heart rate asymmetry is a common phenomenon in healthy children, as observed in 24-h ECGs. Our findings can be used as reference data for future clinical studies on HRA in children.
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Affiliation(s)
- Dominika Zalas
- Department of Pediatric Cardiology, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Waldemar Bobkowski
- Department of Pediatric Cardiology, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Jarosław Piskorski
- Institute of Physics, University of Zielona Gora, 65-516 Zielona Góra, Poland
| | - Przemysław Guzik
- Department of Cardiology-Intensive Therapy, Poznan University of Medical Sciences, 61-701 Poznań, Poland
- Correspondence:
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Fisher JP, Roche J, Turner R, Walzl A, Roveri G, Gatterer H, Siebenmann C. Hypobaric hypoxia and cardiac baroreflex sensitivity in young women. Am J Physiol Heart Circ Physiol 2022; 323:H1048-H1054. [PMID: 36240437 PMCID: PMC9678423 DOI: 10.1152/ajpheart.00452.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We sought to determine the effects of prolonged moderate hypobaric hypoxia (HH) on cardiac baroreflex sensitivity (cBRS) in young women and whether these effects are a consequence of the reduced arterial oxygen (O2) tension and/or increased pulmonary ventilation in HH. We hypothesized that HH would reduce cBRS and that this effect would be counteracted by acute restoration of the inspiratory partial pressure of O2 ([Formula: see text]) and/or voluntary attenuation of pulmonary ventilation. Twelve healthy women (24.0 ± 4.2 yr) were studied before (day 0) and twice during a sojourn in a hypobaric chamber (∼8 h, day 1; 4 days, day 4) where barometric pressure corresponded to ∼3,500-m altitude. Minute ventilation (V̇e; pneumotachometer), heart rate (electrocardiogram), and arterial pressure (finger volume clamp method) were recorded. cBRS was calculated using transfer function analysis between systolic pressure and RR interval. Assessments were made during 1) spontaneous breathing and (in HH only), 2) controlled breathing (reducing V̇e by ∼1 to 2 L/min), and 3) breathing a hyperoxic gas mixture that normalized [Formula: see text]. During spontaneous breathing, HH decreased cBRS (12.5 ± 7.1, 8.9 ± 4.4, and 7.4 ± 3.0 ms/mmHg on days 0, 1, and 4, respectively; P = 0.018). The normalization of [Formula: see text] increased cBRS (10.6 ± 3.3 and 10.7 ± 6.1 ms/mmHg on days 1 and 4) in HH compared with values observed during spontaneous breathing (P < 0.001), whereas controlled breathing had no effect on cBRS (P = 0.708). These findings indicate that ongoing arterial chemoreflex activation by the reduced arterial O2 tension, independently of the hypoxic ventilatory response, reduces cBRS in young women exposed to extended HH.NEW & NOTEWORTHY We examined the effects of prolonged hypobaric hypoxia (corresponding to ∼3,500-m altitude) on cardiac baroreflex sensitivity (cBRS) in young women and investigated underlying mechanisms. We found that cBRS was reduced in hypoxia and that this reduction was attenuated by acute restoration of inspiratory oxygen partial pressure but not by volitional restraint of pulmonary ventilation. These findings help to elucidate the role of arterial chemoreflex mechanisms in the control of cBRS during hypobaric hypoxia in young women.
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Affiliation(s)
- James P. Fisher
- 1Manaaki Manawa–The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Johanna Roche
- 2Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Rachel Turner
- 2Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Anna Walzl
- 3Department of Anaesthesiology, LMU Klinikum, Ludwig-Maximilians-University München, Munich, Germany
| | - Giulia Roveri
- 2Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Hannes Gatterer
- 2Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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10
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Autonomic Disbalance During Systemic Inflammation is Associated with Oxidative Stress Changes in Sepsis Survivor Rats. Inflammation 2022; 45:1239-1253. [PMID: 34981315 DOI: 10.1007/s10753-021-01617-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/16/2021] [Accepted: 12/17/2021] [Indexed: 12/19/2022]
Abstract
Sepsis affects 31.5 million people worldwide. It is characterized by an intense drop in blood pressure driving to cardiovascular morbidity and mortality. Modern supportive care has increased survival in patients; however, after experiencing sepsis, several complications are observed, which may be potentiated by new inflammatory events. Nevertheless, the interplay between sepsis survivors and a new immune challenge in cardiovascular regulation has not been previously defined. We hypothesized that cecal ligation and puncture (CLP) cause persistent cardiovascular dysfunctions in rats as well as changes in autonomic-induced cardiovascular responses to lipopolysaccharide (LPS). Male Wistar rats had mean arterial pressure (MAP) and heart rate (HR) recorded before and after LPS or saline administration to control or CLP survivor rats. CLP survivor rats had similar baseline MAP and HR when compared to control. LPS caused a drop in MAP accompanied by tachycardia in control, while CLP survivor rats had a noteworthy enhanced MAP and a blunted tachycardia. LPS-induced hemodynamic changes were related to an autonomic disbalance to the heart and resistance vessels that were expressed as an increased low- and high-frequency power of pulse interval in CLP survivors after saline and enhancement in the low-frequency power of systolic arterial pressure in control rats after LPS. LPS-induced plasma interferon γ, but not interleukin-10 surges, was blunted in CLP survivor rats. To further access whether or not LPS-induced autonomic disbalance in CLP survivor rats was associated with oxidative stress dysregulation, superoxide dismutase (SOD) activity and thiobarbituric acid reactive substances (TBARS) plasma levels changes were measured. LPS-induced oxidative stress was higher in CLP survivor rats. These findings indicate that key changes in hemodynamic regulation of CLP survivors rats take place in response to LPS that are associated with oxidative stress changes, i.e., reduced SOD activity and increased TBARS levels.
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11
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Petitjeans F, Geloen A, Pichot C, Leroy S, Ghignone M, Quintin L. Is the Sympathetic System Detrimental in the Setting of Septic Shock, with Antihypertensive Agents as a Counterintuitive Approach? A Clinical Proposition. J Clin Med 2021; 10:4569. [PMID: 34640590 PMCID: PMC8509206 DOI: 10.3390/jcm10194569] [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] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/05/2021] [Accepted: 09/07/2021] [Indexed: 12/14/2022] Open
Abstract
Mortality in the setting of septic shock varies between 20% and 100%. Refractory septic shock leads to early circulatory failure and carries the worst prognosis. The pathophysiology is poorly understood despite studies of the microcirculatory defects and the immuno-paralysis. The acute circulatory distress is treated with volume expansion, administration of vasopressors (usually noradrenaline: NA), and inotropes. Ventilation and anti-infectious strategy shall not be discussed here. When circulation is considered, the literature is segregated between interventions directed to the systemic circulation vs. interventions directed to the micro-circulation. Our thesis is that, after stabilization of the acute cardioventilatory distress, the prolonged sympathetic hyperactivity is detrimental in the setting of septic shock. Our hypothesis is that the sympathetic hyperactivity observed in septic shock being normalized towards baseline activity will improve the microcirculation by recoupling the capillaries and the systemic circulation. Therefore, counterintuitively, antihypertensive agents such as beta-blockers or alpha-2 adrenergic agonists (clonidine, dexmedetomidine) are useful. They would reduce the noradrenaline requirements. Adjuncts (vitamins, steroids, NO donors/inhibitors, etc.) proposed to normalize the sepsis-evoked vasodilation are not reviewed. This itemized approach (systemic vs. microcirculation) requires physiological and epidemiological studies to look for reduced mortality.
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Affiliation(s)
- Fabrice Petitjeans
- Critical Care, Hôpital d’Instruction des Armées Desgenettes, 69003 Lyon, France;
| | - Alain Geloen
- UMR Ecologie Microbienne Lyon (LEM), University of Lyon, 69100 Villeurbanne, France;
| | - Cyrille Pichot
- Critical Care, Hôpital Louis Pasteur, 39108 Dole, France;
| | | | - Marco Ghignone
- Critical Care, JF Kennedy Hospital North Campus, West Palm Beach, FL 33407, USA;
| | - Luc Quintin
- Critical Care, Hôpital d’Instruction des Armées Desgenettes, 69003 Lyon, France;
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12
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Naar J, Jaye D, Neuzil P, Doskar P, Malek F, Linderoth B, Lind G, Stahlberg M. Acute effect of spinal cord stimulation on autonomic nervous system function in patients with heart failure. J Appl Biomed 2021; 19:133-141. [PMID: 34907756 DOI: 10.32725/jab.2021.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/05/2021] [Indexed: 12/31/2022] Open
Abstract
AIMS To test the hypothesis that spinal cord stimulation (SCS) acutely improves heart rate variability (HRV) and baroreceptor sensitivity (BRS) in patients with heart failure (HF). METHODS SCS (15 minutes) was delivered in four different settings: 90% of maximal tolerated stimulation amplitude (MTA) targeting the T1-T4 spinal cord segments (SCS90T1-4), 60% of MTA (SCS60T1-4), 90% of MTA with cranial (SCS90CR) and caudal (SCS90CA) electrode configuration. HRV and BRS were recorded continuously and stimulation was compared to device off. RESULTS Fifteen HF patients were included. SCS90T1-4 did not change the standard deviation of intervals between normal beats (SDNN, p = 0.90), BRS (p = 0.55) or other HRV parameters. In patients with baseline SDNN <50 ms, SCS90T1-4 significantly increased SDNN (p = 0.004). CONCLUSIONS Acute SCS at 60-90% of MTA targeting upper thoracic spinal cord segments does not improve autonomic balance or baroreceptor sensitivity in unselected patients with heart failure but may improve HRV in patients with low SDNN.
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Affiliation(s)
- Jan Naar
- Na Homolce Hospital, Department of Cardiology, Prague, Czech Republic
| | - Deborah Jaye
- Medtronic Plc, Cardiac Rhythm and Heart Failure, Minneapolis, USA
| | - Petr Neuzil
- Na Homolce Hospital, Department of Cardiology, Prague, Czech Republic
| | - Petr Doskar
- Na Homolce Hospital, Department of Cardiology, Prague, Czech Republic
| | - Filip Malek
- Na Homolce Hospital, Department of Cardiology, Prague, Czech Republic
| | - Bengt Linderoth
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Goran Lind
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Marcus Stahlberg
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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13
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Takeda R, Stickford ASL, Best SA, Yoo JK, Hissen SL, Liu YL, Fu Q. Impact of high-salt versus low-salt intake on the response of sympathetic baroreflex sensitivity to orthostasis in women with a history of normal pregnancy. Am J Physiol Regul Integr Comp Physiol 2021; 321:R260-R270. [PMID: 34231375 DOI: 10.1152/ajpregu.00069.2021] [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: 11/22/2022]
Abstract
Previous studies have demonstrated that sympathetic baroreflex sensitivity (BRS) increases during orthostatic stress in humans. We recently showed that dietary salt intake affects sympathetic neural control in healthy premenopausal women. This study aimed to determine whether salt loading versus salt reduction would impact sympathetic BRS during orthostasis in premenopausal women with a history of normal pregnancy. Nine healthy women [42 ± 3 (SD) yr] were given a standardized isocaloric high-salt (250 mEq sodium/day) or low-salt (50 mEq sodium/day) diet for 1 wk each (∼2 mo apart with the order randomized), whereas water intake was ad libitum. Laboratory testing was performed following each high- and low-salt period in the midluteal phase of the menstrual cycle. Hemodynamics and muscle sympathetic nerve activity (MSNA) were measured at baseline (supine; 2 min) and during a graded head-up tilt (30° for 5 min and 60° for 20 min). Sympathetic BRS was assessed during baseline and head-up tilt. Hemodynamics were not different between salt conditions during baseline or tilt. Both supine and upright MSNA indices were lower in high salt than low salt (all P < 0.05), however, there was no interaction effect (P = 0.507-0.996). On moving from supine to upright, sympathetic BRS remained unchanged in high salt but increased in low salt (P = 0.028 for interaction). Thus, salt loading diminishes the responsiveness of sympathetic BRS during orthostasis compared with salt reduction in healthy premenopausal women with prior normal pregnancy. Whether this is one underlying mechanism for salt-induced development of hypertension during ambulation remains to be determined.
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Affiliation(s)
- Ryosuke Takeda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Abigail S L Stickford
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stuart A Best
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeung-Ki Yoo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sarah L Hissen
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yu-Lun Liu
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,The University of Texas Southwestern Medical Center, Dallas, Texas
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14
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O'Brien MW, Al-Hinnawi A, Wu Y, Petterson JL, Shivgulam ME, Johns JA, Frayne RJ, Kimmerly DS. The influence of habitual breaks in sedentary time on cardiovagal baroreflex function. Appl Physiol Nutr Metab 2021; 46:1143-1146. [PMID: 34033724 DOI: 10.1139/apnm-2021-0246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sedentary time has recently been included in the 24-h activity guidelines. However, the impact of habitual sedentary patterns on autonomic cardiovascular regulation are unclear. We tested the hypothesis that more sedentary time and fewer sedentary breaks were associated with lower cardiovagal baroreflex sensitivity. More frequent sedentary breaks, but not total sedentary time, was independently and positively associated with vagally mediated blood pressure control. Breaking up sedentary time could be more important than total sedentary time for cardiovascular health. Novelty: Breaks in sedentary time is an independent predictor of cardiovagal baroreflex sensitivity, with more frequent breaks associated with better vagally mediated blood pressure regulation.
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Affiliation(s)
- Myles W O'Brien
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amera Al-Hinnawi
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yanlin Wu
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jennifer L Petterson
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Madeline E Shivgulam
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jarrett A Johns
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ryan J Frayne
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Derek S Kimmerly
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
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15
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Boutou AK, Dipla K, Zafeiridis A, Markopoulou A, Papadopoulos S, Kritikou S, Panagiotidou E, Stanopoulos I, Pitsiou G. A randomized placebo-control trial of the acute effects of oxygen supplementation on exercise hemodynamics, autonomic modulation, and brain oxygenation in patients with pulmonary hypertension. Respir Physiol Neurobiol 2021; 290:103677. [PMID: 33957299 DOI: 10.1016/j.resp.2021.103677] [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: 12/25/2020] [Revised: 04/05/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The integrative physiological effects of O2 treatment on patients with pulmonary hypertension (PH) during exercise, have not been fully investigated. We simultaneously evaluated, for the first time, the effect of oxygen supplementation on hemodynamic responses, autonomic modulation, tissue oxygenation, and exercise performance in patients with pulmonary arterial hypertension (PAH)/Chronic Thromboembolic PH(CTEPH). MATERIAL-METHODS In this randomized, cross-over, placebo-controlled trial, stable outpatients with PAH/CTEPH underwent maximal cardiopulmonary exercise testing, followed by two submaximal trials, during which they received supplementary oxygen (O2) or medical-air. Continuous, non-invasive hemodynamics were monitored via photophlythesmography. Cerebral and quadriceps muscle oxygenation were recorded via near-infrared spectroscopy. Autonomic function was assessed by heart rate variability; root mean square of successive differences (RMSSD) and standard-deviation-Poincare-plot (SD1) were used as indices of parasympathetic output. Baroreceptor sensitivity (BRS) was assessed throughout the protocols. RESULTS Nine patients (51.4 ± 9.4 years) were included. With O2-supplementation patients exercised for longer (p = 0.01), maintained higher cerebral oxygenated hemoglobin (O2Hb;p = 0.02) levels, exhibited an amelioration in cortical deoxygenation (HHb;p = 0.02), and had higher average cardiac output (CO) during exercise (p < 0.05), compared to medical air; with no differences in muscle oxygenation. With O2-supplementation patients exhibited higher BRS and sample-entropy throughout the protocol (p < 0.05) vs. medical air, and improved the blunted RMSSD, SD1 responses during exercise (p = 0.024). CONCLUSION We show that O2 administration improves BRS and autonomic function during submaximal exercise in PAH/CTEPH, without significantly affecting muscle oxygenation. The improved autonomic function, along with enhancements in cardiovascular function and cerebral oxygenation, probably contributes to increased exercise tolerance with O2-supplementation in PH patients.
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Affiliation(s)
- Afroditi K Boutou
- Department of Respiratory Medicine, "G. Papanikolaou Hospital", Thessaloniki, Greece.
| | - Konstantina Dipla
- Exercise Physiology & Biochemistry Laboratory, Dept. of Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Andreas Zafeiridis
- Exercise Physiology & Biochemistry Laboratory, Dept. of Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | | | - Stavros Papadopoulos
- Exercise Physiology & Biochemistry Laboratory, Dept. of Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Stella Kritikou
- Exercise Physiology & Biochemistry Laboratory, Dept. of Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Evangelia Panagiotidou
- Respiratory Failure Department, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Greece
| | - Ioannis Stanopoulos
- Respiratory Failure Department, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Greece
| | - Georgia Pitsiou
- Respiratory Failure Department, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Greece
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16
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Gilmore S, Hart J, Geddes J, Olsen CH, Mehlsen J, Gremaud P, Olufsen MS. Classification of orthostatic intolerance through data analytics. Med Biol Eng Comput 2021; 59:621-632. [PMID: 33582941 DOI: 10.1007/s11517-021-02314-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 01/15/2021] [Indexed: 11/25/2022]
Abstract
Imbalance in the autonomic nervous system can lead to orthostatic intolerance manifested by dizziness, lightheadedness, and a sudden loss of consciousness (syncope); these are common conditions, but they are challenging to diagnose correctly. Uncertainties about the triggering mechanisms and the underlying pathophysiology have led to variations in their classification. This study uses machine learning to categorize patients with orthostatic intolerance. We use random forest classification trees to identify a small number of markers in blood pressure, and heart rate time-series data measured during head-up tilt to (a) distinguish patients with a single pathology and (b) examine data from patients with a mixed pathophysiology. Next, we use Kmeans to cluster the markers representing the time-series data. We apply the proposed method analyzing clinical data from 186 subjects identified as control or suffering from one of four conditions: postural orthostatic tachycardia (POTS), cardioinhibition, vasodepression, and mixed cardioinhibition and vasodepression. Classification results confirm the use of supervised machine learning. We were able to categorize more than 95% of patients with a single condition and were able to subgroup all patients with mixed cardioinhibitory and vasodepressor syncope. Clustering results confirm the disease groups and identify two distinct subgroups within the control and mixed groups. The proposed study demonstrates how to use machine learning to discover structure in blood pressure and heart rate time-series data. The methodology is used in classification of patients with orthostatic intolerance. Diagnosing orthostatic intolerance is challenging, and full characterization of the pathophysiological mechanisms remains a topic of ongoing research. This study provides a step toward leveraging machine learning to assist clinicians and researchers in addressing these challenges. Graphical abstract Machine learning tools utilized to analyze heart rate (HR) and blood pressure (BP) time-series data from syncope and control patients. Results show that machine learning can provide accurate classification of disease groups for 98% of patients and we identified two subgroups within the control patients differentiated by their BP response.
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Affiliation(s)
- Steven Gilmore
- North Carolina State University, Raleigh, NC, 27695, USA
| | - Joseph Hart
- Sandia National Laboratories, Albuquerque, NM, 87123, USA
| | - Justen Geddes
- North Carolina State University, Raleigh, NC, 27695, USA
| | | | - Jesper Mehlsen
- Rigshospitalet, University of Copenhagen, 2100, Copenhagen Ø, Denmark
| | - Pierre Gremaud
- North Carolina State University, Raleigh, NC, 27695, USA
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17
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Armelin VA, Braga VHDS, Teixeira MT, Guagnoni IN, Wang T, Florindo LH. The nonpharmacological sequence method provides a reliable evaluation of baroreflex sensitivity in fish. JOURNAL OF EXPERIMENTAL ZOOLOGY PART 2021; 335:348-358. [PMID: 33503334 DOI: 10.1002/jez.2448] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 11/10/2022]
Abstract
The most commonly used technique to study the barostatic regulation of blood pressure in ectothermic vertebrates consists of determining the heart rate response to pharmacological manipulations of blood pressure, the so-called "Oxford method." Although well established, the Oxford method has some important limitations, such as induction of hypervolemia in small animals and undesired effects of vasoactive drugs on central and peripheral baroreflex components. As an alternative, the sequence method, which consists in the computerized evaluation of naturally-occurring baroreflex adjustments of heart rate without the need for pharmacological administrations, was developed to study baroreflexes. In the present study, we compare this sequence method with the Oxford technique in two teleost species with different life styles, and we assess the optimal software configuration for the employment of the sequence method in fish. Calculation of baroreflex gain through the sequence method was adequate and reliable when the software was configured to search for baroreflex sequences with a minimum length of three cardiac cycles with a delay of one cardiac cycle between fluctuations in mean ventral aortic blood pressure and reflex changes in pulse interval. When properly configured, the sequence and the Oxford methods yielded similar determinations of the baroreflex gain in fish.
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Affiliation(s)
- Vinicius A Armelin
- Department of Physiology, University of São Paulo (USP), São Paulo, SP, Brazil.,Department of Zoology and Botany, São Paulo State University (UNESP), São José do Rio Preto, SP, Brazil.,National Institute of Science and Technology in Comparative Physiology (INCT-FAPESP/CNPq), Rio Claro, SP, Brazil
| | - Victor H da Silva Braga
- Department of Zoology and Botany, São Paulo State University (UNESP), São José do Rio Preto, SP, Brazil.,National Institute of Science and Technology in Comparative Physiology (INCT-FAPESP/CNPq), Rio Claro, SP, Brazil
| | - Mariana T Teixeira
- Department of Zoology and Botany, São Paulo State University (UNESP), São José do Rio Preto, SP, Brazil.,National Institute of Science and Technology in Comparative Physiology (INCT-FAPESP/CNPq), Rio Claro, SP, Brazil
| | - Igor N Guagnoni
- Department of Zoology and Botany, São Paulo State University (UNESP), São José do Rio Preto, SP, Brazil.,National Institute of Science and Technology in Comparative Physiology (INCT-FAPESP/CNPq), Rio Claro, SP, Brazil
| | - Tobias Wang
- National Institute of Science and Technology in Comparative Physiology (INCT-FAPESP/CNPq), Rio Claro, SP, Brazil.,Section for Zoophysiology, Department of Bioscience, Aarhus University (AU), Aarhus, Denmark
| | - Luiz H Florindo
- Department of Zoology and Botany, São Paulo State University (UNESP), São José do Rio Preto, SP, Brazil.,National Institute of Science and Technology in Comparative Physiology (INCT-FAPESP/CNPq), Rio Claro, SP, Brazil.,Aquaculture Center (CAUNESP), São Paulo State University (UNESP), Jaboticabal, SP, Brazil
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18
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Meah VL, Kimber ML, Khurana R, Howse R, Hornberger LK, Steinback CD, Davenport MH. Cardioautonomic control in healthy singleton and twin pregnancies. J Appl Physiol (1985) 2020; 130:923-932. [PMID: 33356983 DOI: 10.1152/japplphysiol.00707.2020] [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: 11/22/2022] Open
Abstract
In conjunction with significant cardiovascular adaptation, changes in cardioautonomic balance, specifically greater sympathetic activation and vagal withdrawal, are considered normal adaptations to healthy singleton pregnancy. Cardiovascular adaptation to twin pregnancy is more profound than that of singleton pregnancies; however, the changes in cardioautonomic control during multifetal gestation are unknown. To address this gap, beat-by-beat blood pressure (photoplethysmography) and heart rate (lead II electrocardiogram) were measured continuously in 25 twin pregnancies and 25 singleton pregnancies (matched for age, prepregnancy body mass index, and gestational age) during 10 min of rest. Data extracted from a 3- to 5-min period were used to analyze heart rate variability (HRV), blood pressure variability (BPV), cardiovagal baroreflex gain, and cardiac intervals as indicators of cardioautonomic control. Independent t tests were used to determine statistical differences between groups (α = 0.05), and the false rate discovery was determined to adjust for multiple comparisons. Resting heart rate was greater in twin compared with singleton pregnancies (91 ± 10 vs. 81 ± 10 beats/min; P = 0.001), but blood pressure was not different. Individuals with twin pregnancies had lower HRV, evidenced by lower standard deviation of R-R intervals (32 ± 11 vs. 47 ± 18 ms; P = 0.001), total power (1,035 ± 810 vs. 1,945 ± 1,570 ms2; P = 0.004), and high frequency power (224 ± 262 vs. 810 ± 806 ms2; P < 0.001) compared with singleton pregnancies. There were no differences in cardiac intervals, BPV, and cardiovagal baroreflex gain between groups. Our findings suggest that individuals with twin pregnancies have greater sympathetic and lower parasympathetic contributions to heart rate and that cardiac, but not vascular, autonomic control is impacted during twin compared with singleton pregnancy.NEW & NOTEWORTHY Individuals with healthy twin pregnancies had lower overall heart rate variability compared with those with singleton pregnancies at similar gestational ages. These results suggest a greater sympathetic and reduced parasympathetic contribution to cardiac control in twin pregnancies. Baseline heart rate was elevated, while arterial pressure and spontaneous cardiovagal baroreflex gain were not different between groups. This was result of the upward resetting of the cardiovagal baroreflex during healthy twin pregnancy, thus maintaining arterial pressure.
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Affiliation(s)
- Victoria L Meah
- Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Miranda L Kimber
- Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Rshmi Khurana
- Departments of Medicine and Obstetrics and Gynecology, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lisa K Hornberger
- Division of Cardiology, Department of Pediatrics, Fetal and Neonatal Cardiology Program, Women's and Children Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Craig D Steinback
- Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada.,Neurovascular Health Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Margie H Davenport
- Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
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19
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Longrois D, Petitjeans F, Simonet O, de Kock M, Belliveau M, Pichot C, Lieutaud T, Ghignone M, Quintin L. Clinical Practice: Should we Radically Alter our Sedation of Critical Care Patients, Especially Given the COVID-19 Pandemics? Rom J Anaesth Intensive Care 2020; 27:43-76. [PMID: 34056133 PMCID: PMC8158317 DOI: 10.2478/rjaic-2020-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The high number of patients infected with the SARS-CoV-2 virus requiring care for ARDS puts sedation in the critical care unit (CCU) to the edge. Depth of sedation has evolved over the last 40 years (no-sedation, deep sedation, daily emergence, minimal sedation, etc.). Most guidelines now recommend determining the depth of sedation and minimizing the use of benzodiazepines and opioids. The broader use of alpha-2 adrenergic agonists ('alpha-2 agonists') led to sedation regimens beginning at admission to the CCU that contrast with hypnotics+opioids ("conventional" sedation), with major consequences for cognition, ventilation and circulatory performance. The same doses of alpha-2 agonists used for 'cooperative' sedation (ataraxia, analgognosia) elicit no respiratory depression but modify the autonomic nervous system (cardiac parasympathetic activation, attenuation of excessive cardiac and vasomotor sympathetic activity). Alpha-2 agonists should be selected only in patients who benefit from their effects ('personalized' indications, as opposed to a 'one size fits all' approach). Then, titration to effect is required, especially in the setting of systemic hypotension and/or hypovolemia. Since no general guidelines exist for the use of alpha-2 agonists for CCU sedation, our clinical experience is summarized for the benefit of physicians in clinical situations in which a recommendation might never exist (refractory delirium tremens; unstable, hypovolemic, hypotensive patients, etc.). Because the physiology of alpha-2 receptors and the pharmacology of alpha-2 agonists lead to personalized indications, some details are offered. Since interactions between conventional sedatives and alpha-2 agonists have received little attention, these interactions are addressed. Within the existing guidelines for CCU sedation, this article could facilitate the use of alpha-2 agonists as effective and safe sedation while awaiting large, multicentre trials and more evidence-based medicine.
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Affiliation(s)
- D Longrois
- Départements d’Anesthésie-Réanimation, Université Paris-Diderot and Paris VII Sorbonne-Paris-Cité, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris and UMR 5698, Paris, France
| | - F Petitjeans
- Hôpital d’Instruction des Armées Desgenettes, Lyon, France
| | - O Simonet
- Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
| | - M de Kock
- Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
| | - M Belliveau
- Hôpital de St Jerome, St Jérôme, Québec, Canada
| | - C Pichot
- Hôpital Louis Pasteur, Dole, France
| | - Th Lieutaud
- Hôpital de Bourg en BresseBourg-en-BresseFrance
- Centre de Recherche en Neurosciences(TIGER,UMR CRNS 5192-INSERM 1098), Lyon-Bron, France
| | - M Ghignone
- J.F. Kennedy Hospital North Campus, West Palm Beach, Florida, USA
| | - L Quintin
- Hôpital d’Instruction des Armées Desgenettes, Lyon, France
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20
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Efficacy of Paced Breathing at the Low-frequency Peak on Heart Rate Variability and Baroreflex Sensitivity. Appl Psychophysiol Biofeedback 2020; 45:31-37. [PMID: 31781925 DOI: 10.1007/s10484-019-09453-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We developed a simple method for identifying resonance frequency by focusing on the spectral peak of the low-frequency (LF) component of heart rate variability (HRV) and examined the hypothesis that paced breathing at an accurate resonance frequency increases HRV and baroreflex sensitivity (BRS). We assessed a peak frequency of the LF component of the resting HRV by using power spectral analysis under respiratory control at 0.25 Hz, and a resonance frequency, which was evaluated by using the standard breathing maneuver (Lehrer 2007). We examined the effects of paced breathing at the peak frequency of the LF component (Spectral condition) and paced breathing at the resonance frequency as determined by the standard breathing maneuver (Standard condition) on HRV and BRS in 28 healthy college students and young adults. Electrocardiogram, respiration, and noninvasive continuous blood pressure was recorded during a 5-min baseline, followed by a 5-min paced breathing session. Results indicated that the BRS increased during the breathing session under both conditions, but the increase in BRS under the Spectral condition was higher than the Standard condition (p < .05). The LF amplitude increased during the breathing session under both conditions (p < .001), although the difference between the conditions was not significant. These results suggest that paced breathing at the peak frequency of the LF component enhanced the autonomic baroreflex function. Moreover, assessment of the LF-peak may provide more accurate information on resonance frequency for paced breathing during HRV biofeedback.
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21
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Nuckols VR, Holwerda SW, Luehrs RE, DuBose LE, Stroud AK, Brandt D, Betz AM, Fiedorowicz JG, Scroggins SM, Santillan DA, Grobe JL, Sigmund CD, Santillan MK, Pierce GL. Beat-to-Beat Blood Pressure Variability in the First Trimester Is Associated With the Development of Preeclampsia in a Prospective Cohort: Relation With Aortic Stiffness. Hypertension 2020; 76:1800-1807. [PMID: 32951467 DOI: 10.1161/hypertensionaha.120.15019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Women with preeclampsia, a hypertensive disorder of pregnancy, exhibit greater beat-to-beat blood pressure variability (BPV) in the third trimester after clinical onset of the disorder. However, it remains unknown whether elevated BPV precedes the development of preeclampsia. A prospective study cohort of 139 women (age 30.2±4.0 years) were enrolled in early pregnancy (<14 weeks gestation). BPV was quantified by time domain analyses of 10-minute continuous beat-to-beat blood pressure recordings via finger photoplethysmography in the first, second, and third trimesters. Aortic stiffness (carotid-femoral pulse wave velocity) and spontaneous cardiovagal baroreflex sensitivity were also measured each trimester. Eighteen women (13%) developed preeclampsia. Systolic BPV was higher in all trimesters among women who developed versus did not develop preeclampsia (first: 4.8±1.3 versus 3.7±1.2, P=0.001; second: 5.1±1.8 versus 3.8±1.1, P=0.02; third: 5.2±0.8 versus 4.0±1.1 mm Hg, P=0.002). Elevated first trimester systolic BPV was associated with preeclampsia (odds ratio, 1.94 [95% CI, 1.27-2.99]), even after adjusting for risk factors (age, body mass index, systolic blood pressure, history of preeclampsia, and diabetes mellitus) and was a significant predictor of preeclampsia (area under the receiver operator characteristic curve=0.75±0.07; P=0.002). Carotid-femoral pulse wave velocity was elevated in the first trimester among women who developed preeclampsia (5.9±0.8 versus 5.2±0.8 m/s; P=0.002) and was associated with BPV after adjustment for mean blood pressure (r=0.26; P=0.005). First trimester baroreflex sensitivity did not differ between groups (P=0.23) and was not related to BPV (P=0.36). Elevated systolic BPV is independently associated with the development of preeclampsia as early as the first trimester, possibly mediated in part by higher aortic stiffness.
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Affiliation(s)
- Virginia R Nuckols
- From the Departments of Health and Human Physiology (V.R.N., S.W.H., R.E.L., L.E.D., A.K.S., G.L.P.), University of Iowa, Iowa City, IA
| | - Seth W Holwerda
- From the Departments of Health and Human Physiology (V.R.N., S.W.H., R.E.L., L.E.D., A.K.S., G.L.P.), University of Iowa, Iowa City, IA.,the Abboud Cardiovascular Research Center (S.W.H., M.K.S., G.L.P.), University of Iowa, Iowa City, IA
| | - Rachel E Luehrs
- From the Departments of Health and Human Physiology (V.R.N., S.W.H., R.E.L., L.E.D., A.K.S., G.L.P.), University of Iowa, Iowa City, IA
| | - Lyndsey E DuBose
- From the Departments of Health and Human Physiology (V.R.N., S.W.H., R.E.L., L.E.D., A.K.S., G.L.P.), University of Iowa, Iowa City, IA
| | - Amy K Stroud
- From the Departments of Health and Human Physiology (V.R.N., S.W.H., R.E.L., L.E.D., A.K.S., G.L.P.), University of Iowa, Iowa City, IA
| | - Debra Brandt
- Obstetrics and Gynecology (D.B., A.M.B., S.M.S., D.A.S., M.K.S.), University of Iowa, Iowa City, IA
| | - Alexandria M Betz
- Obstetrics and Gynecology (D.B., A.M.B., S.M.S., D.A.S., M.K.S.), University of Iowa, Iowa City, IA
| | - Jess G Fiedorowicz
- Psychiatry (J.G.F.), University of Iowa, Iowa City, IA.,Epidemiology (J.G.F.), University of Iowa, Iowa City, IA.,Internal Medicine (J.G.F.), University of Iowa, Iowa City, IA
| | - Sabrina M Scroggins
- Obstetrics and Gynecology (D.B., A.M.B., S.M.S., D.A.S., M.K.S.), University of Iowa, Iowa City, IA
| | - Donna A Santillan
- Obstetrics and Gynecology (D.B., A.M.B., S.M.S., D.A.S., M.K.S.), University of Iowa, Iowa City, IA
| | - Justin L Grobe
- Departments of Physiology (J.L.G., C.D.S.), Medical College of Wisconsin, Milwaukee, WI.,Biomedical Engineering (J.L.G.), Medical College of Wisconsin, Milwaukee, WI.,Cardiovascular Research Center (J.L.G., C.D.S.), Medical College of Wisconsin, Milwaukee, WI
| | - Curt D Sigmund
- Departments of Physiology (J.L.G., C.D.S.), Medical College of Wisconsin, Milwaukee, WI.,Cardiovascular Research Center (J.L.G., C.D.S.), Medical College of Wisconsin, Milwaukee, WI
| | - Mark K Santillan
- Obstetrics and Gynecology (D.B., A.M.B., S.M.S., D.A.S., M.K.S.), University of Iowa, Iowa City, IA.,the Abboud Cardiovascular Research Center (S.W.H., M.K.S., G.L.P.), University of Iowa, Iowa City, IA
| | - Gary L Pierce
- From the Departments of Health and Human Physiology (V.R.N., S.W.H., R.E.L., L.E.D., A.K.S., G.L.P.), University of Iowa, Iowa City, IA.,the Abboud Cardiovascular Research Center (S.W.H., M.K.S., G.L.P.), University of Iowa, Iowa City, IA.,Fraternal Order of Eagles Diabetes Research Center (G.L.P.), University of Iowa, Iowa City, IA
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22
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Khadka R, Narang R, Jaryal AK, Patel C, Deepak KK. Severe Cardiac Dysautonomia and Sudden Death in a Patient Presenting with Anginal Symptoms in Absence of Cardiovascular and Other Diseases: A Case Report. ACTA ACUST UNITED AC 2020; 58:261-264. [PMID: 32417866 PMCID: PMC7580456 DOI: 10.31729/jnma.4828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Angina is a type of chest pain, experienced by patients with ischemic heart diseases. Cardiac autonomic modulation as assessed by heart rate variability and baroreflex sensitivity is found reduced in ischemic heart disease patients. Marked reduction in heart rate variability and baroreflex sensitivity in ischemic heart disease patients is found associated with sudden cardiac death. We report a case of a 35-year-old man who presented with angina for the last few months. Thorough investigations showed no evidence of any cardiac or other systemic diseases. However, his cardiovascular autonomic modulation (as assessed by heart rate variability) and spontaneous baroreflex sensitivity were markedly reduced. The patient had sudden death within 6 months of follow-up. Reportedly, no other specific abnormalities were found before death. This case report suggests that patients presenting with typical chest pain as angina may have severe dysautonomia and risk of sudden death even in the absence of cardiovascular or any other known end-organ diseases.
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Affiliation(s)
- Rita Khadka
- Department of Basic and Clinical Physiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Rajiv Narang
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Jaryal
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Chetan Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kishore Kumar Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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23
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Draghici AE, Taylor JA. Cardiovagal baroreflex gain relates to sensory loss after spinal cord injury. Auton Neurosci 2020; 226:102667. [PMID: 32247945 DOI: 10.1016/j.autneu.2020.102667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/28/2020] [Accepted: 03/21/2020] [Indexed: 12/15/2022]
Abstract
Spinal cord injury (SCI) leads to autonomic nervous system damage, resulting in loss of sympathetic control to the vasculature and the heart proportional to injury level. Given maintained cardiac parasympathetic control, we hypothesized that SCI demonstrates a compensatory, higher baroreflex gain compared to able-bodied that relates to injury level (neurological and/or sensory). We compared baroreflex gain (average and across 10-20, 20-30, and 30-40 mmHg input stimuli) derived from neck chamber technique in SCI (N = 29; neurological level C1-T10, sensory zone of partial preservation C4-S4/5; ≤2 yrs since injury) and able-bodied (N = 14). Average gain tended to be higher in able-bodied compared to SCI (p = 0.06), primarily due to higher gains at 10-20 and 20-30 mmHg (p = 0.03, p = 0.06). In SCI, although gain was not related to neurological level, average gain and gain at 10-20 mmHg was related to sensory zone of partial preservation and resting RR-interval (all p < 0.02). Multiple regression showed that both sensory level and RR-interval were strongly predictive of average baroreflex gain (r2 = 0.41, p < 0.01) and gain at 10-20 mmHg (r2 = 0.51, p < 0.01); gain decreased with higher sensory zone of partial preservation and lower resting RR-interval. Moreover, gain was significantly lower in those with high sensory level compared to both able-bodied (average gain and gain at 10-20 and 20-30 mmHg p < 0.01) and those with low level injury (all p < 0.05). In SCI, sensory zone of partial preservation is more predictive of gain than neurological level. This might reflect that those with high level sensory injuries may have the lowest likelihood of intact cardiac sympathetic innervation and therefore lesser cardiac vagal responsiveness due to vagal-sympathetic interactions.
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Affiliation(s)
- Adina E Draghici
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States of America; Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA, United States of America.
| | - J Andrew Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States of America; Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA, United States of America
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24
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O'Brien MW, Johns JA, Dorey TW, Frayne RJ, Fowles JR, Mekary S, Kimmerly DS. Meeting international aerobic physical activity guidelines is associated with enhanced cardiovagal baroreflex sensitivity in healthy older adults. Clin Auton Res 2019; 30:139-148. [PMID: 31606797 DOI: 10.1007/s10286-019-00641-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/30/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Cardiovagal baroreflex sensitivity (cvBRS) reflects the efficiency of modulating heart rate in response to changes in systolic blood pressure. International guidelines recommend that older adults achieve at least 150 min of moderate-vigorous physical activity per week. We tested the hypothesis that older adults who achieve these guidelines will exhibit greater cardiovagal baroreflex sensitivity versus those who do not. METHODS A cross-sectional comparison of older adults who did (active, 66 ± 5 years, 251 ± 79 min/week; n = 19) and who did not (inactive, 68 ± 7 years, 89 ± 32 min/week; n = 17) meet the activity guidelines. Beat-by-beat R-R intervals (electrocardiography) and systolic blood pressure (finger photoplethysmography) were recorded. Spontaneous cardiovagal baroreflex sensitivity was assessed using the sequence technique from 10 min of resting supine data. Cardiovagal baroreflex function was also measured during early phase II and phase IV of the Valsalva maneuver. Peak oxygen uptake was determined during maximal cycle ergometry. Moderate-vigorous intensity physical activity and time spent sedentary were assessed over 5 days using the PiezoRx and activPAL, respectively. RESULTS Groups had similar peak oxygen uptake (active 25 ± 9 vs. inactive 22 ± 6 ml/kg/min; p = 0.218) and sedentary time (active 529 ± 60 vs. inactive 568 ± 88 min/day; p = 0.130). However, the active group had greater (all, p < 0.019) cvBRS at rest (9.1 ± 2.7 vs. 5.0 ± 1.9 ms/mmHg), during phase II (8.2 ± 3.8 vs. 5.4 ± 2.1 ms/mmHg), and during phase IV (9.9 ± 3.8 vs. 5.6 ± 1.6 ms/mmHg). In the pooled sample, moderate-vigorous physical activity was positively correlated (all, p < 0.015) with spontaneous (R = 0.427), phase II (R = 0.447), and phase IV cvBRS (R = 0.629). CONCLUSIONS Independent of aerobic fitness and sedentary time, meeting activity guidelines was associated with superior cardiovagal baroreflex sensitivity at rest and during the Valsalva maneuver in older adults.
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Affiliation(s)
- Myles W O'Brien
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, 6230 South Street, Halifax, NS, B3H 4R2, Canada
| | - Jarrett A Johns
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, 6230 South Street, Halifax, NS, B3H 4R2, Canada
| | - Tristan W Dorey
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, 6230 South Street, Halifax, NS, B3H 4R2, Canada
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Science, Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ryan J Frayne
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, 6230 South Street, Halifax, NS, B3H 4R2, Canada
| | | | - Said Mekary
- School of Kinesiology, Acadia University, Wolfville, NS, Canada
| | - Derek S Kimmerly
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, 6230 South Street, Halifax, NS, B3H 4R2, Canada.
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25
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Wood KN, Murray KR, Greaves DK, Hughson RL. Inflight leg cuff test does not identify the risk for orthostatic hypotension after long-duration spaceflight. NPJ Microgravity 2019; 5:22. [PMID: 31633009 PMCID: PMC6789148 DOI: 10.1038/s41526-019-0082-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 09/18/2019] [Indexed: 11/09/2022] Open
Abstract
Landing day symptoms from orthostatic hypotension after prolonged spaceflight can be debilitating, but severity of these symptoms can be unpredictable and highly individual. We tested the hypothesis that an impaired baroreflex response to an inflight leg cuff test could predict orthostatic intolerance on return to Earth. Eight male astronauts (44 ± 7 years of age (mean ± SD); mean mission length: 167 ± 12 days) participated in a standardized supine-to-sit-to-stand test (5 min-30s-3 min) pre- and postflight, and a 3 min thigh cuff occlusion test pre- and inflight with continuous monitoring of heart rate and arterial blood pressure. The arterial baroreflex was not changed inflight as shown by similar reductions in mean arterial pressure (MAP) response to leg cuff deflation (preflight -19 ± 2 mmHg vs. inflight -18 ± 5 mmHg). With the sit/stand test, the nadir of MAP was lower postflight (-17 ± 9 mmHg) than preflight (-11 ± 6 mmHg, p < 0.05). A greater increase in heart rate (25 ± 7; 16 ± 3 bpm) and decrease in stroke volume (-24 ± 11; -6 ± 4 mL) occurred with sit/stand postflight than leg cuffs inflight (p < 0.001). Inflight testing was influenced by elevated cardiac output resulting in a smaller drop in total peripheral resistance. Two of eight subjects exhibited orthostatic hypotension during the postflight stand test; their responses were not predicted by the inflight leg cuff deflation test. These results suggest that the baroreflex response examined by inflight leg cuff deflation was not a reliable indicator of postflight stand responses.
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Affiliation(s)
- Katelyn N Wood
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON Canada
| | - Kevin R Murray
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON Canada
| | - Danielle K Greaves
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON Canada
| | - Richard L Hughson
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON Canada
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26
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Badrov MB, Wood KN, Lalande S, Sawicki CP, Borrell LJ, Barron CC, Vording JL, Fleischhauer A, Suskin N, McGowan CL, Shoemaker JK. Effects of 6 Months of Exercise-Based Cardiac Rehabilitation on Autonomic Function and Neuro-Cardiovascular Stress Reactivity in Coronary Artery Disease Patients. J Am Heart Assoc 2019; 8:e012257. [PMID: 31438760 PMCID: PMC6755845 DOI: 10.1161/jaha.119.012257] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/28/2019] [Indexed: 11/16/2022]
Abstract
Background Autonomic dysregulation represents a hallmark of coronary artery disease (CAD). Therefore, we investigated the effects of exercise-based cardiac rehabilitation (CR) on autonomic function and neuro-cardiovascular stress reactivity in CAD patients. Methods and Results Twenty-two CAD patients (4 women; 62±8 years) were studied before and following 6 months of aerobic- and resistance-training-based CR. Twenty-two similarly aged, healthy individuals (CTRL; 7 women; 62±11 years) served as controls. We measured blood pressure, muscle sympathetic nerve activity, heart rate, heart rate variability (linear and nonlinear), and cardiovagal (sequence method) and sympathetic (linear relationship between burst incidence and diastolic blood pressure) baroreflex sensitivity during supine rest. Furthermore, neuro-cardiovascular reactivity during short-duration static handgrip (20s) at 40% maximal effort was evaluated. Six months of CR lowered resting blood pressure (P<0.05), as well as muscle sympathetic nerve activity burst frequency (48±8 to 39±11 bursts/min; P<0.001) and burst incidence (81±7 to 66±17 bursts/100 heartbeats; P<0.001), to levels that matched CTRL and improved sympathetic baroreflex sensitivity in CAD patients (P<0.01). Heart rate variability (all P>0.05) and cardiovagal baroreflex sensitivity (P=0.11) were unchanged following CR, yet values were not different pre-CR from CTRL (all P>0.05). Furthermore, before CR, CAD patients displayed greater blood pressure and muscle sympathetic nerve activity reactivity to static handgrip versus CTRL (all P<0.05); yet, responses were reduced following CR (all P<0.05) to levels observed in CTRL. Conclusions Six months of exercise-based CR was associated with marked improvement in baseline autonomic function and neuro-cardiovascular stress reactivity in CAD patients, which may play a role in the reduced cardiac risk and improved survival observed in patients following exercise training.
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Affiliation(s)
- Mark B. Badrov
- School of KinesiologyWestern UniversityLondonOntarioCanada
| | | | - Sophie Lalande
- School of KinesiologyWestern UniversityLondonOntarioCanada
| | | | | | | | | | | | - Neville Suskin
- Cardiac Rehabilitation and Secondary Prevention Program of St. Joseph's Health Care LondonLondonOntarioCanada
- Department of Medicine (Cardiology) and Program of Experimental MedicineWestern UniversityLondonOntarioCanada
| | - Cheri L. McGowan
- School of KinesiologyWestern UniversityLondonOntarioCanada
- Department of KinesiologyUniversity of WindsorWindsorOntarioCanada
| | - J. Kevin Shoemaker
- School of KinesiologyWestern UniversityLondonOntarioCanada
- Department of Physiology and PharmacologyWestern UniversityLondonOntarioCanada
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27
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Sodium Intake and Hypertension. Nutrients 2019; 11:nu11091970. [PMID: 31438636 PMCID: PMC6770596 DOI: 10.3390/nu11091970] [Citation(s) in RCA: 294] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 12/24/2022] Open
Abstract
The close relationship between hypertension and dietary sodium intake is widely recognized and supported by several studies. A reduction in dietary sodium not only decreases the blood pressure and the incidence of hypertension, but is also associated with a reduction in morbidity and mortality from cardiovascular diseases. Prolonged modest reduction in salt intake induces a relevant fall in blood pressure in both hypertensive and normotensive individuals, irrespective of sex and ethnic group, with larger falls in systolic blood pressure for larger reductions in dietary salt. The high sodium intake and the increase in blood pressure levels are related to water retention, increase in systemic peripheral resistance, alterations in the endothelial function, changes in the structure and function of large elastic arteries, modification in sympathetic activity, and in the autonomic neuronal modulation of the cardiovascular system. In this review, we have focused on the effects of sodium intake on vascular hemodynamics and their implication in the pathogenesis of hypertension.
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28
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Mannoji H, Saku K, Nishikawa T, Tohyama T, Kamada K, Abe K, Sunagawa G, Kishi T, Sunagawa K, Tsutsui H. Estimation of the baroreflex total loop gain by the power spectral analysis of continuous arterial pressure recordings. Am J Physiol Heart Circ Physiol 2019; 316:H828-H839. [PMID: 30608176 DOI: 10.1152/ajpheart.00681.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Baroreflex dysfunction contributes to the pathogenesis of cardiovascular diseases. The baroreflex comprises a negative feedback loop to stabilize arterial pressure (AP); its pressure-stabilizing capacity is defined as the gain ( G) of the transfer function ( H) of the baroreflex total loop. However, no method exists to evaluate G in a clinical setting. A feedback system with H attenuates pressure disturbance (PD) to PD/(1 + H). We hypothesized that the baroreflex attenuates the power spectrum density (PSD) of AP in the baroreflex functioning frequency range. We created graded baroreflex dysfunction in rats using a modified sinoaortic denervation (SAD) method [SAD; control (no SAD): n = 9; partial SAD (SAD in the right carotid sinus): n = 6, and total SAD (SAD in the bilateral carotid sinuses): n = 6] and evaluated the PSD of 12-h telemetric AP recordings in the light phase. Using the ratio of PSD at 0.01-0.1 Hz (PSD slope), we normalized them with the PSD in rats with complete baroreflex failure and derived the baroreflex index (BRI), which directly reflects G. We compared BRI and G obtained from a baroreflex open-loop experiment (reference G). The PSD slope became steeper with progression of baroreflex dysfunction. BRI (control: 2.00 ± 0.31, partial SAD: 1.28 ± 0.30, and total SAD: 0.06 ± 0.10, P < 0.05) was linearly correlated with reference G ( R2 = 0.91, P < 0.01). BRI accurately estimated G of the baroreflex and may serve as a novel tool for estimating the pressure-stabilizing capacity of the baroreflex in clinical settings. NEW & NOTEWORTHY This study proposed a novel method to estimate the gain of the baroreflex total loop, the so-called "baroreflex index" (BRI). BRI focuses on action potential variability in the frequency domain, considering baroreflex low-pass filter characteristics within 0.01-0.1 Hz. We demonstrated that BRI was linearly correlated with the reference gain of baroreflex in rats. Thus, BRI may contribute greatly to the development of a clinical tool for estimating baroreflex pressure-stabilizing capacity.
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Affiliation(s)
- Hiroshi Mannoji
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Keita Saku
- Department of Advanced Risk Stratification for Cardiovascular Disease, Center for Disruptive Cardiovascular Medicine, Kyushu University , Fukuoka , Japan
| | - Takuya Nishikawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Takeshi Tohyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Kazuhiro Kamada
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Kiyokazu Abe
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Genya Sunagawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Takuya Kishi
- Department of Advanced Risk Stratification for Cardiovascular Disease, Center for Disruptive Cardiovascular Medicine, Kyushu University , Fukuoka , Japan
| | - Kenji Sunagawa
- Department of Therapeutic Regulation of Cardiovascular Homeostasis, Center for Disruptive Cardiovascular Medicine, Kyushu University , Fukuoka , Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
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29
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Hupin D, Pichot V, Berger M, Sforza E, Raffin J, Lietar C, Poyraz E, Maudoux D, Barthelemy JC, Roche F. Obstructive Sleep Apnea in Cardiac Rehabilitation Patients. J Clin Sleep Med 2018; 14:1119-1126. [PMID: 29991415 DOI: 10.5664/jcsm.7206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 03/01/2018] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Although regular physical activity improves obstructive sleep apnea (OSA) in the general population, this finding has not been assessed in postmyocardial infarction (MI) patients in a rehabilitation setting (coronary artery disease, CAD). We aimed to determine whether cardiac rehabilitation may benefit post-MI patients in terms of OSA disease and associated autonomic nervous system (ANS) activity. METHODS Consecutive post-MI patients participating in the ambulatory cardiac rehabilitation program of St-Etienne University Hospital were included in this study. The apnea-hypopnea index calculated from electrocardiogram (ECG)-derived respiration (AHIEDR) was obtained through nocturnal Holter ECG recordings. According to AHIEDR, patients were classified as normal, mild, moderate, or severe OSA (< 5, 5-14, 15-29, ≥ 30, respectively). Physiological performance (peak VO2) was established via cardiopulmonary exercise testing. ANS activity was evaluated through spontaneous baroreflex sensibility as well as heart rate variability analysis. RESULTS Of the 105 patients with CAD and OSA included (95 men, 55.2 ± 12.4 years), 100 had at least 1 cardiovascular risk factor (98%) and 52 patients (50%) had an ANS dysfunction. Surprisingly, 68 of these patients with OSA (65%) were free of classical diurnal symptoms usually associated with sleep apnea. In response to cardiac rehabilitation, AHIEDR decreased significantly (-9.3 ± 9.5, P < .0001) only in patients with severe OSA, and the decrease was even greater when peak VO2 and baroreflex sensibility improved beyond 20% compared to basal values (-11.6 ± 9.1, P < .001). CONCLUSIONS Severe OSA in patients with CAD is significantly improved after 2 months of cardiopulmonary rehabilitation. Reviving ANS activity through physical activity might be a target for complementary therapy of OSA in patients with CAD.
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Affiliation(s)
- David Hupin
- EA SNA EPIS 4607, Autonomic Nervous System, University of Lyon, University Jean Monnet, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Vincent Pichot
- EA SNA EPIS 4607, Autonomic Nervous System, University of Lyon, University Jean Monnet, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Mathieu Berger
- Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Emilia Sforza
- EA SNA EPIS 4607, Autonomic Nervous System, University of Lyon, University Jean Monnet, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Jérémy Raffin
- Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Cécile Lietar
- Jacques Lisfranc Medical Faculty, University of Lyon, University Jean Monnet, Saint-Etienne, France
| | - Erkan Poyraz
- Jacques Lisfranc Medical Faculty, University of Lyon, University Jean Monnet, Saint-Etienne, France
| | - Delphine Maudoux
- EA SNA EPIS 4607, Autonomic Nervous System, University of Lyon, University Jean Monnet, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Jean-Claude Barthelemy
- EA SNA EPIS 4607, Autonomic Nervous System, University of Lyon, University Jean Monnet, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Frédéric Roche
- EA SNA EPIS 4607, Autonomic Nervous System, University of Lyon, University Jean Monnet, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
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Visit-to-visit HbA1c variability is inversely related to baroreflex sensitivity independently of HbA1c value in type 2 diabetes. Cardiovasc Diabetol 2018; 17:100. [PMID: 29991356 PMCID: PMC6038306 DOI: 10.1186/s12933-018-0743-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 07/04/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The relationship between long-term glycemic variability (GV) represented by visit-to-visit HbA1c variability and baroreflex sensitivity (BRS) in type 2 diabetes mellitus (T2DM) has not been clarified by previous literature. The present study is the first to examine the relationships between visit-to-visit HbA1c variability and BRS. METHODS This retrospective study initially analyzed data on 94 patients with T2DM. Visit-to-visit HbA1c variability was evaluated using the intrapersonal coefficient of variation (CV), standard deviation (SD), and adjusted SD of 8 or more serial measurements of HbA1c during a 2-year period. The BRS was analyzed using the sequence method. Short-term GV was assessed by measuring the glucose CV during 24-h continuous glucose monitoring (CGM). The primary objective was to determine if there was a relationship between visit-to-visit HbA1c variability (HbA1c CV) and BRS. Secondary objectives were to examine the relationship between other variables and BRS and the respective and combined effects of long-term GV (HbA1c CV) and short-term GV (CGM CV) on BRS. RESULTS A total of 57 patients (mean age 67.2 ± 7.7 years, mean HbA1c 7.3 ± 1.0%) who met this study's inclusion criteria were finally analyzed. In the univariate analysis, HbA1c CV (r = - 0.354, p = 0.007), HbA1c SD (r = - 0.384, p = 0.003), and adjusted HbA1c SD (r = - 0.391, p = 0.003) were significantly related to low levels of BRS. Multiple regression analysis showed that HbA1c CV, HbA1c SD, and adjusted HbA1c SD were inversely related to BRS. Furthermore, although the increase in either long-term GV (HbA1c CV) or short-term GV (CGM CV) as determined by 24-h CGM was inversely correlated with BRS, additional reductions in BRS were not shown in participants with both HbA1c CV and CGM CV values above the median. CONCLUSIONS Visit-to-visit HbA1c variability was inversely related to BRS independently of the mean HbA1c in patients with T2DM. Therefore, visit-to-visit HbA1c variability might be a marker of reduced BRS in T2DM.
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Wesseling KH, Karemaker JM, Castiglioni P, Toader E, Cividjian A, Settels JJ, Quintin L, Westerhof BE. Validity and variability of xBRS: instantaneous cardiac baroreflex sensitivity. Physiol Rep 2018; 5:5/22/e13509. [PMID: 29180481 PMCID: PMC5704083 DOI: 10.14814/phy2.13509] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 11/24/2022] Open
Abstract
Spontaneous oscillations of blood pressure (BP) and interbeat interval (IBI) may reveal important information on the underlying baroreflex control and regulation of BP We evaluated the method of continuously measured instantaneous baroreflex sensitivity by cross correlation (xBRS) validating its mean value against the gold standard of phenylephrine (Phe) and nitroprusside (SNP) bolus injections, and focusing on its spontaneous changes quantified as variability around the mean. For this purpose, we analyzed data from an earlier study of eight healthy males (aged 25-46 years) who had received Phe and SNP in conditions of baseline and autonomic blocking agents: atropine, propranolol, and clonidine. Average xBRS corresponds well to Phe/SNP-BRS, with xBRS levels ranging from 1.2 (atropine) to 102 msec/mmHg (subject asleep under clonidine). Time shifts from BP- to IBI-signal increased from ≤1 sec (maximum correlations within the current heartbeat) to 3-5 sec (under atropine). Plotted on a logarithmic vertical scale, xBRS values show 40% variability (defined as SD/mean) over the whole range in the various conditions, except twice when the subjects had fallen asleep and it dropped to 20%. The xBRS oscillates at frequencies of 0.1 Hz and lower, dominant between 0.02-0.05 Hz. Although xBRS is the result of IBI/BP-changes, no linear coherence was found in the cross-spectra of the xBRS-signal and IBI or BP We speculate that the level of variability in the xBRS-signal may act as a probe into the central nervous condition, as evidenced in the two subjects who fell asleep with high xBRS and only 20% of relative variation.
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Affiliation(s)
| | - John M Karemaker
- Department of Medical Biology (Section Systems Physiology), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Emil Toader
- Department of Physiology, University of Lyon, Lyon, France
| | | | - Jos J Settels
- Edwards Lifesciences BMEYE, Amsterdam, The Netherlands
| | - Luc Quintin
- Department of Physiology, University of Lyon, Lyon, France
| | - Berend E Westerhof
- Department of Medical Biology (Section Systems Physiology), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
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Porta A, Bari V, Maria BD, Cairo B, Vaini E, Malacarne M, Pagani M, Lucini D. Peripheral Resistance Baroreflex During Incremental Bicycle Ergometer Exercise: Characterization and Correlation With Cardiac Baroreflex. Front Physiol 2018; 9:688. [PMID: 29922179 PMCID: PMC5996055 DOI: 10.3389/fphys.2018.00688] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 05/17/2018] [Indexed: 11/13/2022] Open
Abstract
The arm of the baroreflex (BR) controlling peripheral resistances (PR), labeled as BR of PR (prBR), was characterized through an extension of the cardiac BR (cBR) sequence analysis. The method exploits recordings of skin blood flow (SBF) from the palm of the non-dominant hand via a laser Doppler flowmeter and of arterial pressure (AP) from the middle finger of the same hand via a plethysmographic device. PR was estimated beat-by-beat as the ratio of mean AP to mean SBF computed over the same heart period (HP). Peripheral resistances-diastolic arterial pressure (PR-DAP) sequences featuring simultaneous increases of PR and decreases of diastolic AP (DAP) or vice versa were identified and the slope of the regression line in the (DAP, PR) plane was taken as an estimate of prBR sensitivity (BRSprBR). The percentage of prBR sequences (SEQ%prBR) was taken as a measure of prBR involvement and the prBR effectiveness index (EIprBR) was computed as the fraction of DAP sequences capable to drive antiparallel PR variations. Analogous markers were computed over cBR from HP and systolic AP (SAP) variability [i.e., cBR sensitivity (BRScBR), percentage of cBR sequences (SEQ%cBR), and effectiveness index of the cBR (EIcBR)]. prBR and cBR were typified during incremental light-to-moderate bicycle ergometer exercise at 10, 20, and 30% of the maximum effort in 16 healthy subjects (aged from 22 to 58 years, six males). We found that: (i) BRScBR decreased gradually with the challenge, while BRSprBR declined only at the heaviest workload; (ii) SEQ%cBR decreased solely at the lightest workload, while the decline of SEQ%prBR was significant regardless of the intensity of the challenge; (iii) EIprBR and EIcBR were not affected by exercise; (iv) after pooling together all the data regardless of the experimental conditions, BRSprBR and BRScBR were uncorrelated, while SEQ%cBR and SEQ%prBR as well as EIcBR and EIprBR, were significantly and positively correlated; (v) when the correlation between SEQ%cBR and SEQ%prBR and between EIcBR and EIprBR was assessed separately in each experimental condition, it was not systematically detected. This study suggests that prBR characterization provides information complementary to cBR that might be fruitfully exploited to improve patients' risk stratification.
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Affiliation(s)
- Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Vlasta Bari
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Emanuele Vaini
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Mara Malacarne
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, University of Milan, Milan, Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Center, Milan, Italy
| | - Massimo Pagani
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, University of Milan, Milan, Italy
| | - Daniela Lucini
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, University of Milan, Milan, Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Center, Milan, Italy
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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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Sobierajski FM, Purdy GM, Usselman CW, Skow RJ, James MA, Chari RS, Khurana R, Stickland MK, Davidge ST, Devolin M, Steinback CD, Davenport MH. Maternal Physical Activity Is Associated With Improved Blood Pressure Regulation During Late Pregnancy. Can J Cardiol 2018; 34:485-491. [DOI: 10.1016/j.cjca.2018.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 12/16/2022] Open
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Matsutani D, Sakamoto M, Iuchi H, Minato S, Suzuki H, Kayama Y, Takeda N, Horiuchi R, Utsunomiya K. Glycemic variability in continuous glucose monitoring is inversely associated with baroreflex sensitivity in type 2 diabetes: a preliminary report. Cardiovasc Diabetol 2018. [PMID: 29514695 PMCID: PMC5840775 DOI: 10.1186/s12933-018-0683-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background It is presently unclear whether glycemic variability (GV) is associated with baroreflex sensitivity (BRS), which is an early indicator of cardiovascular autonomic neuropathy. The present study is the first to examine the relationships between BRS and GV measured using continuous glucose monitoring (CGM). Methods This was a multicenter, prospective, open-label clinical trial. A total of 102 patients with type 2 diabetes were consecutively recruited for this study. GV was assessed by measuring the standard deviation (SD), glucose coefficient of variation (CV), and the mean amplitude of glycemic excursions (MAGE) during CGM. The BRS was analyzed from electrocardiogram and blood pressure recordings using the sequence method on the first day of hospitalization. Results A total of 94 patients (mean diabetes duration 9.7 ± 9.6 years, mean HbA1c 61.0 ± 16.8 mmol/mol [7.7 ± 1.5%]) were analyzed. In the univariate analysis, CGM-SD (r = − 0.375, p = 0.000), CGM-CV (r = − 0.386, p = 0.000), and MAGE (r = − 0.395, p = 0.000) were inversely related to BRS. In addition to GV, the level of BRS correlated with the coefficient of variation in the R–R intervals (CVR-R) (r = 0.520, p = 0.000), heart rate (HR) (r = − 0.310, p = 0.002), cardio-ankle vascular index (CAVI) (r = − 0.326, p = 0.001), age (r = − 0.519, p = 0.000), and estimated glomerular filtration rate (eGFR) (r = 0.276, p = 0.007). Multiple regression analysis showed that CGM-CV and MAGE were significantly related to a decrease in BRS. These findings remained after adjusting the BRS for age, sex, hypertension, dyslipidemia, HR, eGFR, CAVI, and CGM-mean glucose. Additionally, BRS was divided according to quartiles of the duration of diabetes (Q1–4). BRS decreased after a 2-year duration of diabetes independently of age and sex. Conclusions GV was inversely related to BRS independently of blood glucose levels in type 2 diabetic patients. Measurement of BRS may have the potential to predict CV events in consideration of GV. Trial registration UMIN Clinical Trials Registry UMIN000025964, 28/02/2017 Electronic supplementary material The online version of this article (10.1186/s12933-018-0683-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daisuke Matsutani
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masaya Sakamoto
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Hiroyuki Iuchi
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Souichirou Minato
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hirofumi Suzuki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yosuke Kayama
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Norihiko Takeda
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ryuzo Horiuchi
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kazunori Utsunomiya
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Different estimation methods of spontaneous baroreflex sensitivity have different predictive value in heart failure patients. J Hypertens 2018; 35:1666-1675. [PMID: 28399043 DOI: 10.1097/hjh.0000000000001377] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Several methods have been developed so far to estimate cardiac baroreflex sensitivity (BRS) through the analysis of spontaneous fluctuations of systolic arterial pressure (SAP) and R-R interval. Their relative performance in predicting cardiac mortality in heart failure patients is not known. The aim of this study was to compare the prognostic value of a set of representative indexes of spontaneous BRS in these patients. METHODS We studied 228 stable, moderate-to-severe heart failure patients with reduced ejection fraction, in sinus rhythm, who underwent an 8-min supine recording of ECG, arterial blood pressure and respiration during paced breathing (15 breaths/min). BRS was estimated according to the following methods: sequence (BRSSeq); nonparametric transfer function in the low-frequency band (BRSTF_NP-LF); parametric spectral computed in the low-frequency and high-frequency bands (BRSPS-LF and BRSPS-HF); parametric transfer function computed in the low-frequency and high-frequency bands (BRSTF_P-LF and BRSTF_P-HF); model-based closed loop (BRSCL); and bivariate phase-rectified signal averaging (BRSPRSA). RESULTS During a median follow-up of 36 months, 45 patients experienced a cardiac event. Only BRSTF_NP-LF, BRSPS-LF, BRSTF_P-LF and BRSPRSA were significantly associated with the outcome (P < 0.01), and statistical significance remained (P ≤ 0.03) after adjusting for clinical covariates. BRSTF_NP-LF and BRSPRSA also significantly improved the risk classification. CONCLUSION This study shows that different spontaneous BRS indexes have different predictive value in patients with heart failure. It also shows that the prognostic information of BRS estimates is linked to SAP and RR oscillations in the low-frequency band.
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Sárközi A, Cseh D, Gerlei Z, Kollai M. Reduced neural baroreflex sensitivity is related to enhanced endothelial function in patients with end-stage liver disease. Scand J Gastroenterol 2018; 53:193-199. [PMID: 29272958 DOI: 10.1080/00365521.2017.1401118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Reduced baroreflex sensitivity (BRS) is a frequent complication in end-stage liver disease, but the underlying mechanism is unknown. We investigated the mechanical and neural components of BRS. Increased nitric oxide (NO) production has been reported in end-stage liver failure. Based on earlier experiments, we hypothesised that enhanced endothelial function might affect baroreflex function. Therefore, we explored the relation between endothelial function and the components of BRS. MATERIALS AND METHODS We enrolled 24 patients and 23 controls. BRS was determined by the spontaneous sequence method. Mechanical component was characterised by the distensibility coefficient (DC) of common carotid artery. Neural component was estimated as the ratio of integrated BRS and DC. Endothelial function was quantified by flow-mediated dilation (FMD) of the brachial artery. RESULTS Integrated BRS was reduced in patients [7.00 (5.80-9.25) vs. 11.1 (8.50-14.80) ms/mmHg]. The mechanical component was not different in the two groups, whereas neural component showed significant reduction in patients (3.54 ± 1.20 vs. 4.48 ± 1.43 ms/10-3). FMD was higher in patients (9.81 ± 3.77 vs. 5.59 ± 1.36%). FMD and neural BRS were directly related in controls (r = 0.62), but inversely related in patients (r = -0.49). CONCLUSIONS Baroreflex impairment in end-stage liver disease might be explained by deterioration of the neural component, while the mechanical component appears to be preserved. Endothelial NO may enhance BRS in health; however, central endothelial overproduction of NO likely contributes to the reduction of neural component of BRS in patients awaiting liver transplantation.
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Affiliation(s)
- Adrienn Sárközi
- a Department of Physiology , Semmelweis University , Budapest , Hungary
| | - Domonkos Cseh
- a Department of Physiology , Semmelweis University , Budapest , Hungary
| | - Zsuzsanna Gerlei
- b Department of Transplantation and Surgery , Semmelweis University , Budapest , Hungary
| | - Márk Kollai
- a Department of Physiology , Semmelweis University , Budapest , Hungary
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Bhati P, Shenoy S, Hussain ME. Exercise training and cardiac autonomic function in type 2 diabetes mellitus: A systematic review. Diabetes Metab Syndr 2018; 12:69-78. [PMID: 28888482 DOI: 10.1016/j.dsx.2017.08.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/20/2017] [Indexed: 02/07/2023]
Abstract
Cardiac autonomic neuropathy (CAN) is a common complication of type 2 diabetes mellitus (T2DM). It has been found to independently predict all cause and cardiovascular disease (CVD) mortality. It remains unclear whether exercise training could improve autonomic control in T2DM patients. The purpose of this study was to systematically review the effects of exercise training on cardiac autonomic function in T2DM patients. Electronic databases (MEDLINE, CENTRAL, PEDro, Scopus and Web of science) were systematically searched to retrieve relevant evidence. Clinical trials administering exercise training for at least 4 weeks and examining either heart rate variability (HRV), baroreflex sensitivity (BRS), heart rate recovery (HRR) as outcome measures were eligible. Eighteen articles were found to be relevant and were then assessed for characteristics and quality. Fifteen studies out of 18 found that exercise training leads to positive improvements in autonomic function of T2DM patients. Exercise participation enhances cardiac autonomic function of type 2 diabetics and therefore should be implemented in their management programs.
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Affiliation(s)
- Pooja Bhati
- DiabetResearch Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India.
| | - Shweta Shenoy
- DiabetResearch Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India.
| | - M Ejaz Hussain
- DiabetResearch Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India.
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De Maria B, Bari V, Ranucci M, Pistuddi V, Ranuzzi G, Takahashi ACM, Catai AM, Dalla Vecchia L, Cerutti S, Porta A. Separating arterial pressure increases and decreases in assessing cardiac baroreflex sensitivity via sequence and bivariate phase-rectified signal averaging techniques. Med Biol Eng Comput 2017; 56:1241-1252. [DOI: 10.1007/s11517-017-1765-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/25/2017] [Indexed: 11/29/2022]
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Sluyter JD, Hughes AD, Camargo CA, Lowe A, Scragg RKR. Relations of Demographic and Clinical Factors With Cardiovascular Autonomic Function in a Population-Based Study: An Assessment By Quantile Regression. Am J Hypertens 2017; 31:53-62. [PMID: 28992049 DOI: 10.1093/ajh/hpx134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/15/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The relationships of many factors with cardiovascular autonomic function (CVAF) outcome parameters may not be uniform across the entire distribution of the outcome. We examined how demographic and clinical factors varied with different subgroups of CVAF parameters. METHODS Quantile regression was applied to a cross-sectional analysis of 4,167 adults (56% male; age range, 50-84 years) from 4 ethnic groups (3,419 New Zealand European, 303 Pacific, 227 Maori, and 218 South Asian) and without diagnosed cardiac arrhythmia. Pulse rate variability (root mean square of successive differences (RMSSD) and SD of pulse intervals) and baroreflex sensitivity were response variables. Independent variables were age, sex, ethnicity, brachial and aortic blood pressure (BP) variables, body mass index (BMI), and diabetes. RESULTS Ordinary linear regression showed that age, sex, Pacific and Maori ethnicity, BP variables, BMI, and diabetes were associated with CVAF parameters. But quantile regression revealed that, across CVAF percentiles, the slopes for these relationships: (i) varied by more than 10-fold in several cases and sometimes changed direction and (ii) noticeably differed in magnitude often (by >3-fold in several cases) compared to ordinary linear regression coefficients. For instance, age was inversely associated with RMSSD at the 10th percentile of this parameter (β = -0.12 ms/year, 95% confidence interval = -0.18 to -0.09 ms/year) but had a positive relationship at the 90th percentile (β = 3.17 ms/year, 95% confidence interval = 2.50 to 4.04 ms/year). CONCLUSIONS The relationships of demographic and clinical factors with CVAF parameters are, in many cases, not uniform. Quantile regression provides an improved assessment of these associations.
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Affiliation(s)
- John D Sluyter
- Epidemiology and Biostatistics Section, School of Population Health, University of Auckland, New Zealand
| | - Alun D Hughes
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Sciences, University College London, UK
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, USA
| | - Andrew Lowe
- Institute for Biomedical Technologies, Auckland University of Technology, New Zealand
| | - Robert K R Scragg
- Epidemiology and Biostatistics Section, School of Population Health, University of Auckland, New Zealand
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Wood KN, Badrov MB, Speechley MR, Shoemaker JK. Regional cerebral cortical thickness correlates with autonomic outflow. Auton Neurosci 2017. [DOI: 10.1016/j.autneu.2017.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Weber TM, Lackner HK, Roessler A, Papousek I, Kolovetsiou-Kreiner V, Lucovnik M, Schmid-Zalaudek K, Lang U, Moertl MG. Heart rate variability and baroreceptor reflex sensitivity in early- versus late-onset preeclampsia. PLoS One 2017; 12:e0186521. [PMID: 29053723 PMCID: PMC5650147 DOI: 10.1371/journal.pone.0186521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 10/03/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine whether there are differences in autonomic nervous system function in early- versus late-onset preeclampsia. METHODS Matched case-control study. Cases were defined as singleton pregnancies with preeclampsia at < 34+0 weeks of gestation (early-onset preeclampsia) and ≥ 34+0 weeks of gestation (late-onset preeclampsia). For each case in each of the preeclampsia subgroups, three "control"uncomplicated singleton pregnancies were matched by maternal age, height, and week of gestation. Blood pressure and heart rate were measured continuously for 30 minutes in each participant. Baroreceptor reflex sensitivity (assessed using sequence technique), time and frequency domain heart rate variability measures, as SDNN, RMSSD, LFRRI, HFRRI and LF/HFRRI of R-R intervals, were compared between groups (p<0.05 significant). RESULTS 24 women with preeclampsia (10 with early-onset and 14 with late-onset preeclampsia) and 72 controls were included in the study. SDNN, RMSSD and HFRRI were significantly higher in the late-onset preeclampsia group compared to gestational age matched controls (p = 0.033, p = 0.002 and p = 0.018, respectively). No significant differences in SDNN RMSSD and HFRRI between early-onset preeclampsia group and gestational age matched controls were observed (p = 0.304, p = 0.325 and p = 0.824, respectively). Similarly, baroreceptor reflex sensitivity was higher in late-onset preeclampsia compared to controls at ≥ 34 weeks (p = 0.037), but not different between early-onset preeclampsia compared to controls at < 34 weeks (p = 0.50). CONCLUSIONS Heart rate variability and baroreceptor reflex sensitivity are increased in late- but not early-onset preeclampsia compared to healthy pregnancies. This indicates a better autonomic nervous system mediated adaptation to preeclampsia related cardiovascular changes in late-onset disease.
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Affiliation(s)
| | - Helmut Karl Lackner
- Department of Physiology, Medical University of Graz, Graz, Austria
- Department of Medical Engineering, Graz University of Technology, Graz, Austria
| | - Andreas Roessler
- Department of Physiology, Medical University of Graz, Graz, Austria
| | - Ilona Papousek
- Department of Psychology, Biological Psychology Unit, University of Graz, Graz, Austria
| | | | - Miha Lucovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Uwe Lang
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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Huber DA, Bazilio D, Lorenzon F, Sehnem S, Pacheco L, Anselmo-Franci JA, Lima FB. Cardiovascular Autonomic Responses in the VCD Rat Model of Menopause: Effects of Short- and Long-Term Ovarian Failure. Reprod Sci 2017; 25:1093-1105. [PMID: 29025323 DOI: 10.1177/1933719117734318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
After menopause, hypertension elevates the risk of cardiac diseases, one of the major causes of women's morbidity. The gradual depletion of ovarian follicles in rats, induced by 4-vinylcyclohexene diepoxide (VCD), is a model for studying the physiology of menopause. 4-Vinylcyclohexene diepoxide treatment leads to early ovarian failure (OF) and a hormonal profile comparable to menopause in humans. We have hypothesized that OF can compromise the balance between sympathetic and parasympathetic tones of the cardiovascular system, shifting toward dominance of the former. We aimed to study the autonomic modulation of heart and blood vessels and the cardiovascular reflexes in rats presenting short-term (80 days) or long-term (180 days) OF induced by VCD. Twenty-eight-day-old Wistar rats were submitted to VCD treatment (160 mg/kg, intraperitoneally) or vehicle (control) for 15 consecutive days and experiments were conducted at 80 or 180 days after the onset of treatment. Long-term OF led to an increase in the sympathetic activity to blood vessels and an impairment in the baroreflex control of the heart, evoked by physiological changes in arterial pressure. Despite that, long-term OF did not cause hypertension during the 180 days of exposure. Short-term OF did not cause any deleterious effect on the cardiovascular parameters analyzed. These data indicate that long-term OF does not disrupt the maintenance of arterial pressure homeostasis in rats but worsens the autonomic cardiovascular control. In turn, this can lead to cardiovascular complications, especially when associated with the aging process seen during human menopause.
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Affiliation(s)
- Domitila A Huber
- 1 Departamento de Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade, Federal de Santa Catarina-UFSC, Florianópolis, Santa Catarina, Brazil.,2 Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina-UFSC, Florianópolis, Santa Catarina, Brazil
| | - Darlan Bazilio
- 1 Departamento de Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade, Federal de Santa Catarina-UFSC, Florianópolis, Santa Catarina, Brazil
| | - Flaviano Lorenzon
- 2 Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina-UFSC, Florianópolis, Santa Catarina, Brazil
| | - Sibele Sehnem
- 2 Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina-UFSC, Florianópolis, Santa Catarina, Brazil
| | - Lucas Pacheco
- 1 Departamento de Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade, Federal de Santa Catarina-UFSC, Florianópolis, Santa Catarina, Brazil
| | - Janete A Anselmo-Franci
- 3 Departamento de Morfologia, Estomatologia e Fisiologia, Faculdade de Odontologia de Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Fernanda B Lima
- 1 Departamento de Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade, Federal de Santa Catarina-UFSC, Florianópolis, Santa Catarina, Brazil.,2 Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina-UFSC, Florianópolis, Santa Catarina, Brazil
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Ondrusova K, Svacinova J, Javorka M, Novak J, Novakova M, Novakova Z. Impaired Baroreflex Function during Orthostatic Challenge in Patients after Spinal Cord Injury. J Neurotrauma 2017; 34:3381-3387. [PMID: 28605971 DOI: 10.1089/neu.2017.4989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The level of spinal cord injury (SCI) affects baroreflex regulation of blood pressure. While a parasympathetic cardiac chronotropic effect is preserved, baroreflex response could be impaired by sympathetic dysfunction under the SCI level. This study was aimed to evaluate the baroreflex function in SCI patients by the analysis of causal interaction between systolic blood pressure (SBP) and inter-beat intervals (IBI). Blood pressure was continuously recorded in 13 cervical SCI patients (CSCI), nine thoracic SCI (ThSCI) and 13 able-bodied controls (Con) during two phases: sitting (PS) and orthostatic challenge (PO). Beat-to-beat SBP and IBI sequences were obtained from continuous blood pressure recording. Closed loop of SBP-IBI interaction was mathematically opened by bivariate autoregressive model; causal coherence and baroreflex sensitivity (BRS) were calculated in baroreflex direction. Coherence quantifies causal synchronicity between SBP and IBI. The gain of transfer function from SBP to IBI represents BRS. PS (medians of CSCI/ThSCI/Con) coherence was 0.28/0.33/0.25 (no significant difference) and PS BRS was 6.98/7.54/6.66 (no difference). PO coherence was 0.18/0.58/0.45 (CSCI < ThCSI and Con; p < 0.01) and PO BRS was 2.38/5.87/6.22 (CSCI < ThCSI and Con; p < 0.01). For position change effect, there was no change in CSCI coherence; for ThSCI and Con, PS < PO (p < 0.05). For BRS in the CSCI group, PS < PO (p < 0.01); for ThSCI and Con, there was no change. BRS and coherence correlated negatively with SCI level (p < 0.01). In conclusion, baroreflex dysfunction in SCI patients was detected using causal analysis methods during orthostatic challenge only. Baroreflex dysfunction is probably an important mechanism of the more expressed blood pressure decrease associated with CSCI. The severity of autonomic dysfunction was related to SCI level.
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Affiliation(s)
| | - Jana Svacinova
- 1 Department of Physiology, Masaryk University , Brno, Czech Republic
| | - Michal Javorka
- 2 Department of Physiology, Comenius University in Bratislava , Martin, Slovakia .,3 Biomedical Center Martin, Comenius University in Bratislava , Martin, Slovakia
| | - Jan Novak
- 1 Department of Physiology, Masaryk University , Brno, Czech Republic
| | - Marie Novakova
- 1 Department of Physiology, Masaryk University , Brno, Czech Republic .,4 International Clinical Research Center, St. Anne's University Hospital Brno , Brno, Czech Republic
| | - Zuzana Novakova
- 1 Department of Physiology, Masaryk University , Brno, Czech Republic
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Cardiac autonomic modulation induced by doxorubicin in a rodent model of colorectal cancer and the influence of fullerenol pretreatment. PLoS One 2017; 12:e0181632. [PMID: 28727839 PMCID: PMC5519181 DOI: 10.1371/journal.pone.0181632] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 07/04/2017] [Indexed: 12/13/2022] Open
Abstract
The very effective anticancer drug doxorubicin (DOX) is known to have cardiotoxic side effects, which could be accompanied by autonomic modulation. Autonomic disbalance might even be an initiating mechanism underlying DOX-induced cardiotoxicity and can be studied noninvasively by the analysis of heart rate variability (HRV). A number of strategies have been assessed to predict chemotherapy-induced cardiac dysfunction while HRV, a potential detecting tool, has not yet been tested. Thus, we aimed to determine the effect of DOX treatment on HRV in a rat model of colorectal cancer. While pretreatment with fullerenol (Frl) acts protectively on DOX-induced cardiotoxicity, we aimed to test the effect of Frl pretreatment on DOX-induced HRV alterations. After the induction of colorectal cancer, adult male Wistar rats were treated with saline (n = 7), DOX (1.5 mg/kg per week, n = 7) or DOX after pretreatment with Frl (25 mg/kg per week, n = 7) for three weeks (cumulative DOX dose 4.5 mg/kg). One week after treatment rats were anaesthetized, standard ECG was measured and HRV was analyzed in time and frequency domain. During autopsy the intestines and hearts were gathered for biochemical analysis and histopathological examination. DOX treatment significantly decreased parasympathetically mediated high-frequency component (p<0.05) and increased the low-frequency component of HRV (p<0.05), resulting in an increased LF/HF ratio (p<0.05) in cancerous rats. When pretreated with Frl, DOX-induced HRV alterations were prevented: the high-frequency component of HRV increased (p<0.01), the low-frequency decreased (p<0.01), LF/HF ratio decreased consequently (p<0.01) compared to DOX only treatment. In all DOX-treated animals, disbalance of oxidative status in heart tissue and early myocardial lesions were found and were significantly reduced in rats receiving Frl pretreatment. Autonomic modulation accompanied the development of DOX-induced cardiotoxicity in rat model of colorectal cancer and was prevented by Frl pretreatment. Our results demonstrated the positive prognostic power of HRV for the early detection of DOX-induced cardiotoxicity.
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Xu D, Verma AK, Garg A, Bruner M, Fazel-Rezai R, Blaber AP, Tavakolian K. Significant role of the cardiopostural interaction in blood pressure regulation during standing. Am J Physiol Heart Circ Physiol 2017. [PMID: 28626082 DOI: 10.1152/ajpheart.00836.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiovascular and postural control systems have been studied independently despite the increasing evidence showing the importance of cardiopostural interaction in blood pressure regulation. In this study, we aimed to assess the role of the cardiopostural interaction in relation to cardiac baroreflex in blood pressure regulation under orthostatic stress before and after mild exercise. Physiological variables representing cardiovascular control (heart rate and systolic blood pressure), lower limb muscle activation (electromyography), and postural sway (center of pressure derived from force and moment data during sway) were measured from 17 healthy participants (25 ± 2 yr, 9 men and 8 women) during a sit-to-stand test before and after submaximal exercise. The cardiopostural control (characterized by baroreflex-mediated muscle-pump effect in response to blood pressure changes, i.e., muscle-pump baroreflex) was assessed using wavelet transform coherence and causality analyses in relation to the baroreflex control of heart rate. Significant cardiopostural blood pressure control was evident counting for almost half of the interaction time with blood pressure changes that observed in the cardiac baroreflex (36.6-72.5% preexercise and 34.7-53.9% postexercise). Thus, cardiopostural input to blood pressure regulation should be considered when investigating orthostatic intolerance. A reduction of both cardiac and muscle-pump baroreflexes in blood pressure regulation was observed postexercise and was likely due to the absence of excessive venous pooling and a less stressed system after mild exercise. With further studies using more effective protocols evoking venous pooling and muscle-pump activity, the cardiopostural interaction could improve our understanding of the autonomic control system and ultimately lead to a more accurate diagnosis of cardiopostural dysfunctions.NEW & NOTEWORTHY We examined the interaction between cardiovascular and postural control systems during standing before and after mild exercise. Significant cardiopostural input to blood pressure regulation was shown, suggesting the importance of cardiopostural integration when investigating orthostatic hypotension. In addition, we observed a reduction of baroreflex-mediated blood pressure regulation after exercise.
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Affiliation(s)
- Da Xu
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ajay K Verma
- Department of Electrical Engineering, University of North Dakota, Grand Forks, North Dakota; and
| | - Amanmeet Garg
- Department of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Michelle Bruner
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Reza Fazel-Rezai
- Department of Electrical Engineering, University of North Dakota, Grand Forks, North Dakota; and
| | - Andrew P Blaber
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Department of Electrical Engineering, University of North Dakota, Grand Forks, North Dakota; and
| | - Kouhyar Tavakolian
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada; .,Department of Electrical Engineering, University of North Dakota, Grand Forks, North Dakota; and
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Anyfanti P, Triantafyllidou E, Papadopoulos S, Triantafyllou A, Nikolaidis MG, Kyparos A, Vrabas IS, Douma S, Zafeiridis A, Dipla K. Smoking before isometric exercise amplifies myocardial stress and dysregulates baroreceptor sensitivity and cerebral oxygenation. ACTA ACUST UNITED AC 2017; 11:376-384. [DOI: 10.1016/j.jash.2017.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/02/2017] [Accepted: 04/05/2017] [Indexed: 11/15/2022]
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Hampel KG, Elger CE, Surges R. Impaired Baroreflex Sensitivity after Bilateral Convulsive Seizures in Patients with Focal Epilepsy. Front Neurol 2017; 8:210. [PMID: 28572789 PMCID: PMC5435824 DOI: 10.3389/fneur.2017.00210] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/01/2017] [Indexed: 11/29/2022] Open
Abstract
Background Sudden unexpected death in epilepsy (SUDEP) is probably due to an autonomic failure in the early postictal phase after bilateral convulsive seizures (BCS) in the majority of cases. The baroreflex sensitivity (BRS) is an established and reliable biomarker of autonomic function and sudden cardiac death. Objective To investigate whether postictal BRS depends on seizure type. Methods Beat-to-beat systemic blood pressure and heart rate were continuously and non-invasively recorded with the ccNexfin® device in patients with focal epilepsy undergoing video-EEG monitoring. BRS was calculated using the sequence as well as the spectral method. A random mixed linear model was applied to analyze the influence of seizure type on BRS during three different time periods of 15-min length each (interictal, preictal, and postictal). In addition, the possible effects of other factors (hypertension, hemispheric lateralization of ictal activity, epilepsy type, body position, vigilance state) were explored. Data are given as median with interquartile range. Results A total of 26 seizures of 26 patients were analyzed. In BCS (n = 7), BRS significantly dropped from a preictal value of 15.0 ms/mm Hg (13.0–19.4) and an interictal value of 15.6 ms/mm Hg (12.0–20.4) to 3.1 ms/mm Hg (2.7–10.5) during the postictal period (p < 0.0001) according to the sequence method. This finding was replicated with the spectral method. In contrast, focal seizures (n = 19) did not lead to significant alterations of BRS in the postictal phase. Conclusion Postictal BRS depends on the seizure type and is markedly impaired after BCS. The present study provides further evidence for a disturbed autonomic function following BCS. These findings might be related to cardiovascular failure in the context of SUDEP.
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Affiliation(s)
- Kevin G Hampel
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.,Multidisciplinary Epilepsy Unit, Neurology Service, University Hospital La Fe, Valencia, Spain
| | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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Post-Carotid Endarterectomy Hypertension. Part 1: Association with Pre-operative Clinical, Imaging, and Physiological Parameters. Eur J Vasc Endovasc Surg 2017; 54:551-563. [PMID: 28268070 DOI: 10.1016/j.ejvs.2017.01.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 01/24/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE/BACKGROUND Post-endarterectomy hypertension (PEH) is a well recognised, but poorly understood, phenomenon after carotid endarterectomy (CEA) that is associated with post-operative intracranial haemorrhage, hyperperfusion syndrome, and cardiac complications. The aim of the current study was to identify pre-operative clinical, imaging, and physiological parameters associated with PEH. METHODS In total, 106 CEA patients undergoing CEA under general anaesthesia underwent pre-operative evaluation of 24 hour ambulatory arterial blood pressure (BP), baroreceptor sensitivity, cerebral autoregulation, and transcranial Doppler measurement of cerebral blood flow velocity (CBFv) and pulsatility index. Patients who met pre-existing criteria for treating PEH after CEA (systolic BP [SBP] > 170 mmHg without symptoms or SBP > 160 mmHg with headache/seizure/neurological deficit) were treated according to a previously established protocol. RESULTS In total, 40/106 patients (38%) required treatment for PEH at some stage following CEA (26 in theatre recovery [25%], 27 while on the vascular surgical ward [25%]), while seven (7%) had SBP surges > 200 mmHg back on the ward. Patients requiring treatment for PEH had a significantly higher pre-operative SBP (144 ± 11 mmHg vs. 135 ± 13 mmHg; p < .001) and evidence of pre-existing impairment of baroreceptor sensitivity (3.4 ± 1.7 ms/mmHg vs. 5.3 ± 2.8 ms/mmHg; p = .02). However, PEH was not associated with any other pre-operative clinical features, CBFv, or impaired cerebral haemodynamics. Paradoxically, autoregulation was better preserved in patients with PEH. All four cases of hyperperfusion associated symptoms were preceded by PEH. Length of hospital stay was significantly increased in patients with PEH (p < .001). CONCLUSION In this study, where all patients underwent CEA under general anaesthesia, PEH was associated with poorly controlled pre-operative BP and impaired baroreceptor sensitivity, but not with other peripheral or central haemodynamic parameters, including impaired cerebral autoregulation.
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