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Sevoz-Couche C, Laborde S. Heart rate variability and slow-paced breathing:when coherence meets resonance. Neurosci Biobehav Rev 2022; 135:104576. [DOI: 10.1016/j.neubiorev.2022.104576] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 01/08/2023]
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2
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Cardiac Autonomic Nervous System Activity during Slow Breathing in Supine Position. Rehabil Res Pract 2021; 2021:6619571. [PMID: 33728068 PMCID: PMC7936890 DOI: 10.1155/2021/6619571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 12/18/2022] Open
Abstract
The purpose of this study is to clarify cardiac autonomic nervous system activity during slow breathing exercises in a supine position. Eighteen healthy young males were participated. Heart rate variability was measured for 5 minutes at rest, 5 minutes at slow breathing, and then 5 minutes at rest. As a result, the LF/HF ratio increased with slow breathing, but HF value did not change. We suggest that the increased LF/HF ratio may be due to increased airway resistance. Cardiac autonomic nervous system activity during slow breathing in the supine position was revealed.
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3
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Li K, Rüdiger H, Ziemssen T. Spectral Analysis of Heart Rate Variability: Time Window Matters. Front Neurol 2019; 10:545. [PMID: 31191437 PMCID: PMC6548839 DOI: 10.3389/fneur.2019.00545] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 05/07/2019] [Indexed: 12/22/2022] Open
Abstract
Spectral analysis of heart rate variability (HRV) is a valuable tool for the assessment of cardiovascular autonomic function. Fast Fourier transform and autoregressive based spectral analysis are two most commonly used approaches for HRV analysis, while new techniques such as trigonometric regressive spectral (TRS) and wavelet transform have been developed. Short-term (on ECG of several minutes) and long-term (typically on ECG of 1–24 h) HRV analyses have different advantages and disadvantages. This article reviews the characteristics of spectral HRV studies using different lengths of time windows. Short-term HRV analysis is a convenient method for the estimation of autonomic status, and can track dynamic changes of cardiac autonomic function within minutes. Long-term HRV analysis is a stable tool for assessing autonomic function, describe the autonomic function change over hours or even longer time spans, and can reliably predict prognosis. The choice of appropriate time window is essential for research of autonomic function using spectral HRV analysis.
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Affiliation(s)
- Kai Li
- Autonomic and Neuroendocrinological Lab, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.,Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Heinz Rüdiger
- Autonomic and Neuroendocrinological Lab, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Tjalf Ziemssen
- Autonomic and Neuroendocrinological Lab, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.,Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
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4
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De Souza LA, Ferreira JB, Schein ASDO, Dartora DR, Casali AG, Scassola CMC, Tobaldini E, Montano N, Guzzetti S, Porta A, Irigoyen MC, Casali KR. Optimization of Vagal Stimulation Protocol Based on Spontaneous Breathing Rate. Front Physiol 2018; 9:1341. [PMID: 30319449 PMCID: PMC6168675 DOI: 10.3389/fphys.2018.01341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/05/2018] [Indexed: 11/13/2022] Open
Abstract
Controlled breathing maneuver is being widely applied for cardiovascular autonomic control evaluation and cardiac vagal activation through reduction of breathing rate (BR). However, this maneuver presented contradictory results depending on the protocol and the chosen BR. These variations may be related to the individual intrinsic profile baseline sympathetic tonus, as described before by others. In this study, we evaluated the effect of controlled breathing maneuver on cardiovascular autonomic control in 26 healthy subjects allocated into two protocols: (1) controlled breathing in three different rates (10, 15, and 20 breaths/min) and (2) controlled breathing in rates normalized by the individual spontaneous breathing rate (SBR) at 100, 80, 70, and 50%. Our results showed autonomic responses favorable to vagal modulation with the lower BR maneuvers. Nevertheless, while this activation was variable using the standard protocol, all participants of the normalized protocol demonstrated an increase of vagal modulation at 80% BR (HFnu 80 = 67.5% vs. 48.2%, p < 0.0001). These results suggest that controlled breathing protocols to induce vagal activation should consider the SBR, being limited to values moderately lower than the baseline.
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Affiliation(s)
- Liliane Appratto De Souza
- Institute of Cardiology of Rio Grande do Sul, University Foundation of Cardiology, Porto Alegre, Brazil
| | | | | | - Daniela Ravizzoni Dartora
- Institute of Cardiology of Rio Grande do Sul, University Foundation of Cardiology, Porto Alegre, Brazil
| | - Adenauer Girardi Casali
- Department of Science and Technology, Institute of Science and Technology, Federal University of São Paulo, São José dos Campos, Brazil
| | - Catharina M Carvalho Scassola
- Department of Science and Technology, Institute of Science and Technology, Federal University of São Paulo, São José dos Campos, Brazil
| | - Eleonora Tobaldini
- Department of Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Nicola Montano
- Department of Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Stefano Guzzetti
- Department of Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - 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
| | - Maria Claudia Irigoyen
- Institute of Cardiology of Rio Grande do Sul, University Foundation of Cardiology, Porto Alegre, Brazil.,Hypertension Division, Medicine School, Heart Institute, São Paulo University, São Paulo, Brazil
| | - Karina Rabello Casali
- Institute of Cardiology of Rio Grande do Sul, University Foundation of Cardiology, Porto Alegre, Brazil.,Department of Science and Technology, Institute of Science and Technology, Federal University of São Paulo, São José dos Campos, Brazil
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5
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Li K, Rüdiger H, Haase R, Ziemssen T. An Innovative Technique to Assess Spontaneous Baroreflex Sensitivity with Short Data Segments: Multiple Trigonometric Regressive Spectral Analysis. Front Physiol 2018; 9:10. [PMID: 29403393 PMCID: PMC5786552 DOI: 10.3389/fphys.2018.00010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/05/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: As the multiple trigonometric regressive spectral (MTRS) analysis is extraordinary in its ability to analyze short local data segments down to 12 s, we wanted to evaluate the impact of the data segment settings by applying the technique of MTRS analysis for baroreflex sensitivity (BRS) estimation using a standardized data pool. Methods: Spectral and baroreflex analyses were performed on the EuroBaVar dataset (42 recordings, including lying and standing positions). For this analysis, the technique of MTRS was used. We used different global and local data segment lengths, and chose the global data segments from different positions. Three global data segments of 1 and 2 min and three local data segments of 12, 20, and 30 s were used in MTRS analysis for BRS. Results: All the BRS-values calculated on the three global data segments were highly correlated, both in the supine and standing positions; the different global data segments provided similar BRS estimations. When using different local data segments, all the BRS-values were also highly correlated. However, in the supine position, using short local data segments of 12 s overestimated BRS compared with those using 20 and 30 s. In the standing position, the BRS estimations using different local data segments were comparable. There was no proportional bias for the comparisons between different BRS estimations. Conclusion: We demonstrate that BRS estimation by the MTRS technique is stable when using different global data segments, and MTRS is extraordinary in its ability to evaluate BRS in even short local data segments (20 and 30 s). Because of the non-stationary character of most biosignals, the MTRS technique would be preferable for BRS analysis especially in conditions when only short stationary data segments are available or when dynamic changes of BRS should be monitored.
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Affiliation(s)
- Kai Li
- Autonomic and Neuroendocrinological Lab, Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl-Gustav Carus, Technical University of Dresden, Dresden, Germany.,Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Heinz Rüdiger
- Autonomic and Neuroendocrinological Lab, Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl-Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Rocco Haase
- Autonomic and Neuroendocrinological Lab, Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl-Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Autonomic and Neuroendocrinological Lab, Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl-Gustav Carus, Technical University of Dresden, Dresden, Germany
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6
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Estévez-Báez M, Carricarte-Naranjo C, Jas-García JD, Rodríguez-Ríos E, Machado C, Montes-Brown J, Leisman G, Schiavi A, Machado-García A, Luaces CS, Pié EA. Influence of Heart Rate, Age, and Gender on Heart Rate Variability in Adolescents and Young Adults. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1133:19-33. [PMID: 30414070 DOI: 10.1007/5584_2018_292] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Key autonomic functions are in continuous development during adolescence which can be assessed using the heart rate variability (HRV). However, the influence of different demographic and physiological factors on HRV indices has not been fully explored in adolescents. In this study we aimed to assess the effect of age, gender, and heart rate on HRV indices in two age groups of healthy adolescents (age ranges, 13-16 and 17-20 years) and two groups of healthy young adults (21-24 and 25-30 years). We addressed the issue using 5-min ECG recordings performed in the sitting position in 255 male and female participants. Time, frequency, and informational domains of HRV were calculated. Changes in HRV indices were assessed using a multiple linear regression model to adjust for the effects of heart rate, age, and gender. We found that heart rate produced more significant effects on HRV indices than age or gender. There was a progressive reduction in HRV with increasing age. Sympathetic influence increased with age and parasympathetic influence progressively decreased with age. The influence of gender was manifest only in younger adolescents and young adults. In conclusion, age, gender, and particularly heart rate have a substantial influence on HRV indices, which ought to be considered to avoid biases in the study of the autonomic nervous system development. The lack of the gender-related effects on HRV indices in late adolescence could be related to non-completely achieved maturity of the autonomic mechanisms, which deserves further exploration.
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Affiliation(s)
- Mario Estévez-Báez
- Institute of Neurology and Neurosurgery, Ministry of Health, Havana, Cuba
| | | | | | | | - Calixto Machado
- Institute of Neurology and Neurosurgery, Ministry of Health, Havana, Cuba
| | - Julio Montes-Brown
- Department of Medicine & Health Science, University of Sonora, Hermosillo, Mexico
| | - Gerry Leisman
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel. .,National Institute for Brain and Rehabilitation Sciences, Nazareth, Israel. .,Faculty 'Manuel Fajardo', University of the Medical Sciences, Havana, Cuba.
| | - Adam Schiavi
- Anesthesiology and Critical Care Medicine, Neurosciences Critical Care Division, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | - Eduardo Arrufat Pié
- Institute of Basic and Preclinical Sciences "Victoria de Girón", Havana, Cuba
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7
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Li K, Lindauer C, Haase R, Rüdiger H, Reichmann H, Reuner U, Ziemssen T. Autonomic Dysfunction in Wilson's Disease: A Comprehensive Evaluation during a 3-Year Follow Up. Front Physiol 2017; 8:778. [PMID: 29066979 PMCID: PMC5641386 DOI: 10.3389/fphys.2017.00778] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/22/2017] [Indexed: 01/28/2023] Open
Abstract
Objectives: Wilson's disease is reported to have autonomic dysfunction, but comprehensive evaluation of autonomic function is lacking. Additionally, little is known about the change of autonomic function of Wilson's disease during continuous therapy. We assumed that patients with Wilson's disease had both sympathetic and parasympathetic autonomic impairments, and the autonomic dysfunction might be stable across a 3-year follow-up after years of optimal treatment. Methods: Twenty-six patients with Wilson's disease and twenty-six healthy controls were recruited. Twenty patients in the Wilson's disease group were examined again after a 3-year follow-up. All the participants were evaluated by a questionnaire on dysautonomia symptoms, 24-h blood pressure and heart rate monitoring, and cardiovascular autonomic function examination in various conditions including at rest, deep breathing, Valsalva maneuver, isometric handgrip test and passive tilting. Baroreflex sensitivity and spectral analyses were performed via trigonometric regressive spectral analysis. Results: Patients with Wilson's disease showed autonomic dysfunction mainly in the following aspects: (1) the heart rate was higher than the controls. (2) Valsalva ratio was lower in patients with Wilson's disease compared with the controls. (3) Heart rate increase during isometric hand gripping was smaller in the Wilson's disease patients than the controls. (4) Baroreflex sensitivity was lower during nearly all the cardiovascular autonomic function examinations compared with healthy controls. When tested 3 years later, baroreflex sensitivity at rest decreased compared with baseline. (5) There were mild declines of resting DBP and low frequency component of heart rate variability during the follow-up examination compared with baseline. (6) Subgroup analysis showed that patients initially presenting with neurological symptoms had a higher night-time heart rate, lower expiration: inspiration RR interval ratio (E/I ratio), lower expiration: inspiration RR interval difference (E-I difference), less increase of heart rate and diastolic blood pressure during the handgrip test, and lower baroreflex sensitivity during deep breathing than the control group. (7) Correlation analysis showed that the severity of neurological symptoms was associated with E/I ratio, E-I difference, Valsalva ratio, heart rate change during the handgrip test, and baroreflex sensitivity during deep breathing. Conclusions: The present study reveals cardiovascular autonomic dysfunction involving both sympathetic and parasympathetic branches in Wilson's disease patients, which is especially significant in the patients with neurological onset. Autonomic function is generally stable undergoing optimal maintenance treatment in patients with Wilson's disease. Though there might be mild changes of specific parameters.
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Affiliation(s)
- Kai Li
- Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.,Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Charlotte Lindauer
- Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Rocco Haase
- Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Heinz Rüdiger
- Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Ulrike Reuner
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Tjalf Ziemssen
- Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.,Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
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8
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Hilz MJ, Wang R, Markus J, Ammon F, Hösl KM, Flanagan SR, Winder K, Koehn J. Severity of traumatic brain injury correlates with long-term cardiovascular autonomic dysfunction. J Neurol 2017; 264:1956-1967. [PMID: 28770375 PMCID: PMC5587629 DOI: 10.1007/s00415-017-8581-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/21/2017] [Accepted: 07/25/2017] [Indexed: 01/22/2023]
Abstract
After traumatic brain injury (TBI), central autonomic dysfunction might contribute to long-term increased mortality rates. Central autonomic dysfunction might depend on initial trauma severity. This study was performed to evaluate differences in autonomic modulation at rest and upon standing between patients with a history of mild TBI (post-mild-TBI patients), moderate or severe TBI (post-moderate–severe-TBI patients), and healthy controls. In 20 post-mild-TBI patients (6–78 months after TBI), age-matched 20 post-moderate–severe-TBI patients (6–94 months after TBI) and 20 controls, we monitored respiration, RR intervals (RRI) and systolic blood pressure (BPsys) at supine rest and upon standing. We determined mainly sympathetic low (LF) and parasympathetic high (HF) frequency powers of RRI fluctuations, sympathetically mediated LF-BPsys powers, LF/HF-RRI ratios, normalized (nu) LF-RRI and HF-RRI powers, and compared data between groups, at rest and upon standing (ANOVA with post hoc testing). We correlated autonomic parameters with initial Glasgow Coma Scale (GCS) scores (Spearman test; significance: p < 0.05). Supine BPsys and LFnu-RRI powers were higher while HFnu-RRI powers were lower in post-moderate–severe-TBI patients than post-mild-TBI patients and controls. LFnu-RRI powers were higher and HFnu-RRI powers were lower in post-mild-TBI patients than controls. Upon standing, only post-mild-TBI patients and controls increased LF-BPsys powers and BPsys and decreased HF-RRI powers. GCS scores correlated positively with LFnu-RRI powers, LF/HF-RRI ratios, and inversely with HFnu-RRI powers, at standing position. More than 6 months after TBI, there is autonomic dysfunction at rest and upon standing which is more pronounced after moderate–severe than mild TBI and in part correlates with initial trauma severity.
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Affiliation(s)
- Max J Hilz
- Clinical Department of Autonomic Neurology, University College London, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK. .,Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany. .,Icahn School of Medicine at Mount Sinai, Department of Neurology, New York, NY, USA.
| | - Ruihao Wang
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jörg Markus
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Fabian Ammon
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Katharina M Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Steven R Flanagan
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Klemens Winder
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Julia Koehn
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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9
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Hilz MJ, Liu M, Koehn J, Wang R, Ammon F, Flanagan SR, Hösl KM. Valsalva maneuver unveils central baroreflex dysfunction with altered blood pressure control in persons with a history of mild traumatic brain injury. BMC Neurol 2016; 16:61. [PMID: 27146718 PMCID: PMC4857428 DOI: 10.1186/s12883-016-0584-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 04/29/2016] [Indexed: 02/04/2023] Open
Abstract
Background Patients with a history of mild TBI (post-mTBI-patients) have an unexplained increase in long-term mortality which might be related to central autonomic dysregulation (CAD). We investigated whether standardized baroreflex-loading, induced by a Valsalva maneuver (VM), unveils CAD in otherwise healthy post-mTBI-patients. Methods In 29 healthy persons (31.3 ± 12.2 years; 9 women) and 25 post-mTBI-patients (35.0 ± 13.2 years, 7 women, 4–98 months post-injury), we monitored respiration (RESP), RR-intervals (RRI) and systolic blood pressure (BP) at rest and during three VMs. At rest, we calculated parameters of total autonomic modulation [RRI-coefficient-of-variation (CV), RRI-standard-deviation (RRI-SD), RRI-total-powers], of sympathetic [RRI-low-frequency-powers (LF), BP-LF-powers] and parasympathetic modulation [square-root-of-mean-squared-differences-of-successive-RRIs (RMSSD), RRI-high-frequency-powers (HF)], the index of sympatho-vagal balance (RRI LF/HF-ratios), and baroreflex sensitivity (BRS). We calculated Valsalva-ratios (VR) and times from lowest to highest RRIs after strain (VR-time) as indices of parasympathetic activation, intervals from highest systolic BP-values after strain-release to the time when systolic BP had fallen by 90 % of the differences between peak-phase-IV-BP and baseline-BP (90 %-BP-normalization-times), and velocities of BP-normalization (90 %-BP-normalization-velocities) as indices of sympathetic withdrawal. We compared patient- and control-parameters before and during VM (Mann-Whitney-U-tests or t-tests; significance: P < 0.05). Results At rest, RRI-CVs, RRI-SDs, RRI-total-powers, RRI-LF-powers, BP-LF-powers, RRI-RMSSDs, RRI-HF-powers, and BRS were lower in patients than controls. During VMs, 90 %-BP-normalization-times were longer, and 90 %-BP-normalization-velocities were lower in patients than controls (P < 0.05). Conclusions Reduced autonomic modulation at rest and delayed BP-decrease after VM-induced baroreflex-loading indicate subtle CAD with altered baroreflex adjustment to challenge. More severe autonomic challenge might trigger more prominent cardiovascular dysregulation and thus contribute to increased mortality risk in post-mTBI-patients.
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Affiliation(s)
- Max J Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany.
| | - Mao Liu
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany
| | - Julia Koehn
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany
| | - Ruihao Wang
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany
| | - Fabian Ammon
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany
| | - Steven R Flanagan
- Department of Rehabilitation Medicine, New York University School of Medicine, 240 East 38th Street, New York, NY, 10016, USA
| | - Katharina M Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Prof.-Ernst-Nathan-Strasse 1, 90419, Nuremberg, Germany
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10
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Time- and frequency-domain parameters of heart rate variability and sympathetic skin response in Parkinson's disease. J Neural Transm (Vienna) 2014; 122:419-25. [PMID: 25038873 DOI: 10.1007/s00702-014-1276-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
Abstract
The autonomic nervous system (ANS) is regularly affected in Parkinson's disease (PD). Information on autonomic dysfunction can be derived from e.g. altered heart rate variability (HRV) and sympathetic skin response (SSR). Such parameters can be quantified easily and measured repeatedly which might be helpful for evaluating disease progression and therapeutic outcome. In this 2-center study, HRV and SSR of 45 PD patients and 26 controls were recorded. HRV was measured during supine metronomic breathing and analyzed in time- and frequency-domains. SSR was evoked by repetitive auditory stimulation. Various ANS parameters were compared (1) between patients and healthy controls, (2) to clinical scales (Unified Parkinson's disease rating scale, Mini-Mental State Examination, Becks Depression Inventory), and (3) to disease duration. Root mean square of successive differences (RMSSD) and low frequency/high frequency (LF/HF) ratio differed significantly between PD and controls. Both, HRV and SSR parameters showed low or no association with clinical scores. Time-domain parameters tended to be affected already at early PD stages but did not consistently change with longer disease duration. In contrast, frequency-domain parameters were not altered in early PD phases but tended to be lower (LF, LF/HF ratio), respectively higher (HF) with increasing disease duration. This report confirms previous results of altered ANS parameters in PD. In addition, it suggests that (1) these ANS parameters are not relevantly associated with motor, behavioral, and cognitive changes in PD, (2) time-domain parameters are useful for the assessment of early PD, and (3) frequency-domain parameters are more closely associated with disease duration.
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11
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Music induces different cardiac autonomic arousal effects in young and older persons. Auton Neurosci 2014; 183:83-93. [DOI: 10.1016/j.autneu.2014.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 02/13/2014] [Accepted: 02/18/2014] [Indexed: 11/24/2022]
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12
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Trigonometric regressive spectral analysis: an innovative tool for evaluating the autonomic nervous system. J Neural Transm (Vienna) 2013; 120 Suppl 1:S27-33. [PMID: 23812502 DOI: 10.1007/s00702-013-1054-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/11/2013] [Indexed: 01/01/2023]
Abstract
Biological rhythms, describing the temporal variation of biological processes, are a characteristic feature of complex systems. The analysis of biological rhythms can provide important insights into the pathophysiology of different diseases, especially, in cardiovascular medicine. In the field of the autonomic nervous system, heart rate variability (HRV) and baroreflex sensitivity (BRS) describe important fluctuations of blood pressure and heart rate which are often analyzed by Fourier transformation. However, these parameters are stochastic with overlaying rhythmical structures. R-R intervals as independent variables of time are not equidistant. That is why the trigonometric regressive spectral (TRS) analysis--reviewed in this paper--was introduced, considering both the statistical and rhythmical features of such time series. The data segments required for TRS analysis can be as short as 20 s allowing for dynamic evaluation of heart rate and blood pressure interaction over longer periods. Beyond HRV, TRS also estimates BRS based on linear regression analyses of coherent heart rate and blood pressure oscillations. An additional advantage is that all oscillations are analyzed by the same (maximal) number of R-R intervals thereby providing a high number of individual BRS values. This ensures a high confidence level of BRS determination which, along with short recording periods, may be of profound clinical relevance. The dynamic assessment of heart rate and blood pressure spectra by TRS allows a more precise evaluation of cardiovascular modulation under different settings as has already been demonstrated in different clinical studies.
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13
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Reimann M, Folprecht G, Haase R, Trautmann K, Ehninger G, Reichmann H, Ziemssen F, Ziemssen T. Anti-Vascular endothelial growth factor therapy impairs endothelial function of retinal microcirculation in colon cancer patients - an observational study. EXPERIMENTAL & TRANSLATIONAL STROKE MEDICINE 2013; 5:7. [PMID: 23668549 PMCID: PMC3658870 DOI: 10.1186/2040-7378-5-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 05/09/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND To assess acute effects of bevacizumab (anti-VEGF therapy) on cerebral microvessels and systemic cardiovascular regulation. DESIGN AND SUBJECTS 20 consecutive patients with colorectal cancer (median age: 60.4 years, range 45.5-73.9 years) received bevacizumab intravenously (5 mg/kg) uncoupled of chemotherapy. Prior to and within the first 24 hours after bevacizumab infusion, patients were investigated for retinal endothelial function. A series of a triple 24-hour ambulatory blood pressure measurement was conducted. Retinal endothelial function was determined as flicker light-induced vasodilation. The integrity of baroreflex arc and autonomic cardiovascular control was examined by stimulatory manoeuvres. RESULTS Bevacizumab therapy significantly reduced the vasodilatory capacity of retinal arterioles in response to flicker light. A slight decrease in diastolic pressure and heart rate was observed after bevacizumab infusion but this was unrelated to changes in retinal function. The pressure response upon nitroglycerin was largely preserved after bevacizumab infusion. The proportion of patients with abnormal nocturnal blood pressure regulation increased under anti-angiogenic therapy. Autonomic blood pressure control was not affected by bevacizumab treatment. CONCLUSIONS Bevacizumab acutely impairs microvascular function independent of blood pressure changes. Imaging of the retinal microcirculation seems a valuable tool for monitoring pharmacodynamic effects of bevacizumab. TRIAL REGISTRATION NCT ID: NCT00740168.
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Affiliation(s)
- Manja Reimann
- Autonomic and neuroendocrinological laboratory, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Fetscherstr 74, Germany.,Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Gunnar Folprecht
- Department of Internal Medicine I, University Cancer Center, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Rocco Haase
- Autonomic and neuroendocrinological laboratory, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Fetscherstr 74, Germany.,Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Karolin Trautmann
- Department of Internal Medicine I, University Cancer Center, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Gerhard Ehninger
- Department of Internal Medicine I, University Cancer Center, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Heinz Reichmann
- Autonomic and neuroendocrinological laboratory, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Fetscherstr 74, Germany.,Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Focke Ziemssen
- Center for Ophthalmology, Eberhard Karl University Tuebingen, Tuebingen, Germany
| | - Tjalf Ziemssen
- Autonomic and neuroendocrinological laboratory, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Fetscherstr 74, Germany.,Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
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Reimann M, Julius U, Bornstein S, Fischer S, Reichmann H, Rüdiger H, Ziemssen T. Regular lipoprotein apheresis maintains residual cardiovascular and microvascular function in patients with advanced atherosclerotic disease. ATHEROSCLEROSIS SUPP 2013; 14:135-41. [DOI: 10.1016/j.atherosclerosissup.2012.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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15
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Greater cardiovascular reactivity to a cold stimulus is due to higher cold pain perception in black Africans. J Hypertens 2012; 30:2416-24. [DOI: 10.1097/hjh.0b013e328358faf7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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16
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Postuma RB, Aarsland D, Barone P, Burn DJ, Hawkes CH, Oertel W, Ziemssen T. Identifying prodromal Parkinson's disease: pre-motor disorders in Parkinson's disease. Mov Disord 2012; 27:617-26. [PMID: 22508280 DOI: 10.1002/mds.24996] [Citation(s) in RCA: 390] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Increasing recognition that Parkinson's disease (PD) may start outside of the substantia nigra has led to a rapidly expanding effort to define prodromal stages of PD, before motor signs permit classical diagnosis. Many of these efforts center around the identification of clinical non-motor symptoms and signs of disease. There is now direct evidence that olfaction, rapid eye movement (REM) sleep behavior disorder (RBD), constipation, and depression can be present in prodromal PD. In addition, there is suggestive evidence that visual changes, other autonomic symptoms, and subtle cognitive changes may also be present at prodromal stages. A critical issue in utility of these prodromal markers will be assessment of sensitivity, specificity, and positive and negative predictive values. Although these have yet to be fully defined, olfactory deficits, some visual changes, and autonomic symptoms occur in the majority of PD patients at diagnosis, suggesting good potential sensitivity. However, with the exception of RBD and perhaps some specific autonomic measures, specificity, and positive predictive value of these markers may be insufficient to be used alone as identifiers of prodromal disease. The evidence for the utility of olfaction, RBD, autonomic markers, visual changes, mood disorders, and cognitive loss as markers of prodromal PD and the potential sensitivity and specificity of these markers are summarized.
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Affiliation(s)
- Ronald B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada.
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17
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Reimann M, Hamer M, Schlaich M, Malan NT, Rüdiger H, Ziemssen T, Malan L. Autonomic responses to stress in Black versus Caucasian Africans: the SABPA study. Psychophysiology 2011; 49:454-61. [PMID: 22176778 DOI: 10.1111/j.1469-8986.2011.01328.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 10/11/2011] [Indexed: 11/30/2022]
Abstract
Underlying mechanisms of increased pressor responses to stress in Blacks are poorly understood. Cardiovascular regulation of normotensive Black (n=43) and Caucasian (n=90) Africans was studied during a cold pressor and color-word conflict test. Autonomic evaluation was performed by spectral analysis. Higher diastolic pressor and heart rate responses to the cold pressor test were observed in Black compared to Caucasian Africans. Autonomic efferent outflow to stress was comparable between groups. Transient downregulation of baroreflex during stress was evident in Blacks but not in Caucasians. Greater diastolic pressor responses were related to a higher cardiac reactivity, a baroreflex desensitization, and higher stress perception in Black Africans. Thus, increased stress perception may facilitate cardiac and diastolic hyperreactivity, indirectly affecting baroreflex function in Black Africans.
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Affiliation(s)
- Manja Reimann
- Autonomic and Neuroendocrinological Laboratory Dresden, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.
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18
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Ziemssen T, Reichmann H. Cardiovascular autonomic testing in extrapyramidal disorders. J Neurol Sci 2011; 310:129-32. [PMID: 21839477 DOI: 10.1016/j.jns.2011.07.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 06/28/2011] [Accepted: 07/19/2011] [Indexed: 10/17/2022]
Abstract
Various diagnostic tests are available to demonstrate autonomic failure in extrapyramidal disease. Autonomic function tests can identify parasympathetic and sympathetic dysfunction. While specialized tests are only available in autonomic labs, routine tests such as 24h ambulatory blood pressure measurements can be broadly used in clinical practice eg. as screening tests. In this review, we briefly introduce functional cardiovascular autonomic testing and propose a workup plan for patients with extrapyramidal disease. In all patients with extrapyramidal disease, screening for autonomic dysfunction should be performed. In the case of pathological findings, detailed autonomic testing should be considered with repeated measurements at follow up visits.
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Affiliation(s)
- Tjalf Ziemssen
- ANF-lab, Neurological University Clinic, Dresden, Germany.
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Gasch J, Reimann M, Reichmann H, Rüdiger H, Ziemssen T. Determination of baroreflex sensitivity during the modified Oxford maneuver by trigonometric regressive spectral analysis. PLoS One 2011; 6:e18061. [PMID: 21437258 PMCID: PMC3060917 DOI: 10.1371/journal.pone.0018061] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 02/22/2011] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Differences in spontaneous and drug-induced baroreflex sensitivity (BRS) have been attributed to its different operating ranges. The current study attempted to compare BRS estimates during cardiovascular steady-state and pharmacologically stimulation using an innovative algorithm for dynamic determination of baroreflex gain. METHODOLOGY/PRINCIPAL FINDINGS Forty-five volunteers underwent the modified Oxford maneuver in supine and 60° tilted position with blood pressure and heart rate being continuously recorded. Drug-induced BRS-estimates were calculated from data obtained by bolus injections of nitroprusside and phenylephrine. Spontaneous indices were derived from data obtained during rest (stationary) and under pharmacological stimulation (non-stationary) using the algorithm of trigonometric regressive spectral analysis (TRS). Spontaneous and drug-induced BRS values were significantly correlated and display directionally similar changes under different situations. Using the Bland-Altman method, systematic differences between spontaneous and drug-induced estimates were found and revealed that the discrepancy can be as large as the gain itself. Fixed bias was not evident with ordinary least products regression. The correlation and agreement between the estimates increased significantly when BRS was calculated by TRS in non-stationary mode during the drug injection period. TRS-BRS significantly increased during phenylephrine and decreased under nitroprusside. CONCLUSIONS/SIGNIFICANCE The TRS analysis provides a reliable, non-invasive assessment of human BRS not only under static steady state conditions, but also during pharmacological perturbation of the cardiovascular system.
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Affiliation(s)
- Julia Gasch
- Autonomic and Neuroendocrinological Laboratory, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Manja Reimann
- Autonomic and Neuroendocrinological Laboratory, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
- Research Group Neuro-Metabolism, Department of Neurology and Internal Medicine III, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
- * E-mail:
| | - Heinz Reichmann
- Autonomic and Neuroendocrinological Laboratory, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Heinz Rüdiger
- Autonomic and Neuroendocrinological Laboratory, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
- Research Group Neuro-Metabolism, Department of Neurology and Internal Medicine III, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Tjalf Ziemssen
- Autonomic and Neuroendocrinological Laboratory, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
- Research Group Neuro-Metabolism, Department of Neurology and Internal Medicine III, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
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