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Collard D, Vriend EMC, Galenkamp H, Moll van Charante EP, Vogt L, Westerhof BE, van den Born BJH. Autonomic regulation in different hypertensive phenotypes - the HELIUS study. Blood Press 2023; 32:2270070. [PMID: 37861395 DOI: 10.1080/08037051.2023.2270070] [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: 07/14/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023]
Abstract
Background: Hypertension can be classified into different phenotypes based on systolic and diastolic blood pressure (BP) that carry a different prognosis and may therefore be differently associated with sympathetic activity. We assessed the association between cardiac autonomic function determined from continuous finger BP recordings and hypertensive phenotypes. Methods: We included 10,221 individuals aged between 18-70 years from the multi-ethnic HELIUS study. Finger BP was recorded continuously for 3-5 minutes from which cross-correlation baroreflex sensitivity (xBRS) and heart rate variability (HRV) were determined. Hypertension was classified into isolated systolic (ISH; ≥140/<90), diastolic (IDH; <140/≥90) and combined systolic and diastolic hypertension (SDH; ≥140/≥90). Differences were assessed after stratification by age (younger: ≤40, older: >40 years) and sex, using regression with correction for relevant covariates. For xBRS, values were log-transformed. Results: In younger adults with ISH, xBRS was comparable to normotensive individuals in men (ratio 0.92; 95%CI 0.84-1.01) and women (1.00; 95%CI 0.84-1.20), while xBRS was significantly lower in IDH and SDH (ratios between 0.67 and 0.80). In older adults, all hypertensive phenotypes had significantly lower xBRS compared to normotensives. We found a similar pattern for HRV in men, while in women HRV did not differ between phenotypes. Conclusions: In younger men and women ISH is not associated with a shift towards increased sympathetic control, while IDH and SDH in younger and all hypertensive phenotypes in older participants were associated with increased sympathetic control. This suggests that alterations in autonomic regulation could be a contributing factor to known prognostic disparities between hypertensive phenotypes.
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Affiliation(s)
- D Collard
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - E M C Vriend
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
| | - H Galenkamp
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
| | - E P Moll van Charante
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
| | - L Vogt
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Nephrology, Amsterdam, Amsterdam Cardiovascular Sciences, The Netherlands
| | - B E Westerhof
- Amsterdam UMC, University of Amsterdam, Department of Pulmonary Medicine, Amsterdam, The Netherlands
| | - B J H van den Born
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
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Verhaar BJH, Mosterd CM, Collard D, Galenkamp H, Muller M, Rampanelli E, van Raalte DH, Nieuwdorp M, van den Born BJH. Sex differences in associations of plasma metabolites with blood pressure and heart rate variability: The HELIUS study. Atherosclerosis 2023; 384:117147. [PMID: 37286456 DOI: 10.1016/j.atherosclerosis.2023.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/27/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND AIMS Since plasma metabolites can modulate blood pressure (BP) and vary between men and women, we examined sex differences in plasma metabolite profiles associated with BP and sympathicovagal balance. Our secondary aim was to investigate associations between gut microbiota composition and plasma metabolites predictive of BP and heart rate variability (HRV). METHODS From the HELIUS cohort, we included 196 women and 173 men. Office systolic BP and diastolic BP were recorded, and heart rate variability (HRV) and baroreceptor sensitivity (BRS) were calculated using finger photoplethysmography. Plasma metabolomics was measured using untargeted LC-MS/MS. Gut microbiota composition was determined using 16S sequencing. We used machine learning models to predict BP and HRV from metabolite profiles, and to predict metabolite levels from gut microbiota composition. RESULTS In women, best predicting metabolites for systolic BP included dihomo-lineoylcarnitine, 4-hydroxyphenylacetateglutamine and vanillactate. In men, top predictors included sphingomyelins, N-formylmethionine and conjugated bile acids. Best predictors for HRV in men included phenylacetate and gentisate, which were associated with lower HRV in men but not in women. Several of these metabolites were associated with gut microbiota composition, including phenylacetate, multiple sphingomyelins and gentisate. CONCLUSIONS Plasma metabolite profiles are associated with BP in a sex-specific manner. Catecholamine derivatives were more important predictors for BP in women, while sphingomyelins were more important in men. Several metabolites were associated with gut microbiota composition, providing potential targets for intervention.
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Affiliation(s)
- Barbara J H Verhaar
- Department of Internal and Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Department of Internal Medicine - Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
| | - Charlotte M Mosterd
- Department of Internal and Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Diabetes Center, Department of Internal Medicine, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Didier Collard
- Department of Internal and Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, the Netherlands
| | - Majon Muller
- Department of Internal Medicine - Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Elena Rampanelli
- Department of Internal and Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Daniël H van Raalte
- Department of Internal and Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Diabetes Center, Department of Internal Medicine, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Goteborgs Universitet, Gothenburg, Sweden
| | - Bert-Jan H van den Born
- Department of Internal and Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Department of Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
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Collard D, Velde LVD, Stegehuis VE, Delewi R, Beijk MAM, Zijlstra IJAJ, de Winter RJ, Vogt L, van den Born BJH. Assessment of renal sympathetic control using invasive pressure and flow velocity measurements in humans. Am J Physiol Renal Physiol 2023; 325:F263-F270. [PMID: 37382495 DOI: 10.1152/ajprenal.00031.2023] [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: 02/16/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023] Open
Abstract
Renal sympathetic innervation is important in the control of renal and systemic hemodynamics and is a target for pharmacological and catheter-based therapies. The effect of a physiological sympathetic stimulus using static handgrip exercise on renal hemodynamics and intraglomerular pressure in humans is unknown. We recorded renal arterial pressure and flow velocity in patients with a clinical indication for coronary or peripheral angiography using a sensor-equipped guidewire during baseline, handgrip, rest, and hyperemia following intrarenal dopamine (30 μg/kg). Changes in perfusion pressure were expressed as the change in mean arterial pressure, and changes in flow were expressed as a percentage with respect to baseline. Intraglomerular pressure was estimated using a Windkessel model. A total of 18 patients (61% male and 39% female) with a median age of 57 yr (range: 27-85 yr) with successful measurements were included. During static handgrip, renal arterial pressure increased by 15.2 mmHg (range: 4.2-53.0 mmHg), whereas flow decreased by 11.2%, but with a large variation between individuals (range: -13.4 to 49.8). Intraglomerular pressure increased by 4.2 mmHg (range: -3.9 to 22.1 mmHg). Flow velocity under resting conditions remained stable, with a median of 100.6% (range: 82.3%-114.6%) compared with baseline. During hyperemia, maximal flow was 180% (range: 111%-281%), whereas intraglomerular pressure decreased by 9.6 mmHg (interquartile range: 4.8 to 13.9 mmHg). Changes in renal pressure and flow during handgrip exercise were significantly correlated (ρ = -0.68, P = 0.002). Measurement of renal arterial pressure and flow velocity during handgrip exercise allows the identification of patients with higher and lower sympathetic control of renal perfusion. This suggests that hemodynamic measurements may be useful to assess the response to therapeutic interventions aimed at altering renal sympathetic control.NEW & NOTEWORTHY Renal sympathetic innervation is important in the homeostasis of systemic and renal hemodynamics. We showed that renal arterial pressure significantly increased and that flow decreased during static handgrip exercise using direct renal arterial pressure and flow measurements in humans, but with a large difference between individuals. These findings may be useful for future studies aimed to assess the effect of interventions that influence renal sympathetic control.
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Affiliation(s)
- Didier Collard
- Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lennart van de Velde
- Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Faculty of Science and Technology, Technical Medical Centre, Multi-Modality Medical Imaging Group, University of Twente, Enschede, The Netherlands
| | - Valerie E Stegehuis
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ronak Delewi
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel A M Beijk
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - IJsbrand A J Zijlstra
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Liffert Vogt
- Department of Internal Medicine, Section Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan H van den Born
- Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Collard D, Velde LVD, Stegehuis VE, Delewi R, Beijk MAM, Zijlstra IJAJ, de Winter RJ, Vogt L, van den Born BJH. Assessment of renal sympathetic control using invasive pressure and flow velocity measurements in humans. Am J Physiol Renal Physiol 2023; 325:F263-F270. [DOI: https:/doi.org/10.1152/ajprenal.00031.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 11/30/2023] Open
Abstract
Renal sympathetic innervation is important in the homeostasis of systemic and renal hemodynamics. We showed that renal arterial pressure significantly increased and that flow decreased during static handgrip exercise using direct renal arterial pressure and flow measurements in humans, but with a large difference between individuals. These findings may be useful for future studies aimed to assess the effect of interventions that influence renal sympathetic control.
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Affiliation(s)
- Didier Collard
- Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lennart van de Velde
- Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Faculty of Science and Technology, Technical Medical Centre, Multi-Modality Medical Imaging Group, University of Twente, Enschede, The Netherlands
| | - Valerie E. Stegehuis
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ronak Delewi
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel A. M. Beijk
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Robbert J. de Winter
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Liffert Vogt
- Department of Internal Medicine, Section Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan H. van den Born
- Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Collard D, Westerhof BE, Karemaker JM, Stok WJ, Postema PG, Krediet CTP, Vogt L, van den Born BJH. Automated analysis of finger blood pressure recordings provides insight in determinants of baroreflex sensitivity and heart rate variability-the HELIUS study. Med Biol Eng Comput 2023; 61:1183-1191. [PMID: 36683125 PMCID: PMC10083154 DOI: 10.1007/s11517-023-02768-4] [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: 09/07/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023]
Abstract
Sympathovagal balance is important in the pathogenesis of hypertension and independently associated with mortality. We evaluated the value of automated analysis of cross-correlation baroreflex sensitivity (xBRS) and heart rate variability (HRV) and its relationship with clinical covariates in 13,326 participants from the multi-ethnic HELIUS study. Finger blood pressure (BP) was continuously recorded, from which xBRS, standard deviation of normal-to-normal intervals (SDNN), and squared root of mean squared successive difference between normal-to-normal intervals (RMSDD) were determined. A subset of 3356 recordings > 300 s was used to derive the minimally required duration by comparing shortened to complete recordings, defined as intraclass correlation (ICC) > 0.90. For xBRS and SDNN, 120 s and 180 s were required (ICC 0.93); for RMSDD, 60 s (ICC 0.94) was sufficient. We included 10,252 participants (median age 46 years, 54% women) with a recording > 180 s for the regression. xBRS, SDNN, and RMSDD decreased linearly up to 50 years of age. For xBRS, there was a signification interaction with sex, with for every 10 years a decrease of 4.3 ms/mmHg (95%CI 4.0-4.6) for men and 5.9 ms/mmHg (95%CI 5.6-6.1) for women. Using splines, we observed sex-dependent nonlinearities in the relation with BP, waist-to-hip-ratio, and body mass index. Future studies can help unravel the dynamics of these relations and assess their predictive value. Panel 1 depicts automatic analysis and filtering of finger BP recordings, panel 2 depicts computation of xBRS from interpolated beat to beat data of systolic BP and interbeat interval, and (IBI) SDNN and RMSDD are computed directly from the filtered IBI dataset. Panel 3 depicts the results of large-scale analysis and relation of xBRS with age, sex, blood pressure and body mass index.
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Affiliation(s)
- D Collard
- Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - B E Westerhof
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Biology, Section Systems Physiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J M Karemaker
- Department of Medical Biology, Section Systems Physiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W J Stok
- Department of Medical Biology, Section Systems Physiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - P G Postema
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C T P Krediet
- Department of Internal Medicine, Section Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - L Vogt
- Department of Internal Medicine, Section Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - B J H van den Born
- Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Association between temporal patterns of baroreflex sensitivity after traumatic brain injury and prognosis: a preliminary study. Neurol Sci 2023; 44:1653-1663. [PMID: 36609622 PMCID: PMC10102132 DOI: 10.1007/s10072-022-06579-7] [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: 08/22/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Traumatic brain injury (TBI) may lead to an increase in intracranial pressure (ICP) as well as impairment of cerebral vascular reactivity and the autonomic nervous system. This study aimed to investigate individual patterns of changes in baroreflex sensitivity (BRS) along with the assessment of pressure reactivity index (PRx) and ICP after TBI. MATERIALS AND METHODS Twenty-nine TBI patients with continuous arterial blood pressure (ABP) and ICP monitoring were included. BRS was calculated using the sequential cross-correlation method. PRx was estimated using slow-wave oscillations of ABP and ICP. Outcome was assessed using the Glasgow Outcome Scale. RESULTS Pooled data analysis of the lower breakpoint during the week that followed TBI revealed that BRS reached a minimum about 2 days after TBI. In patients with good outcome, there was a significant increase in BRS during the 7 days following TBI: rp = 0.21; p = 0.008 and the temporal changes in BRS showed either a "U-shaped" pattern or a gradual increase over time. The BRS value after 1.5 days was found to be a significant predictor of mortality (cut-off BRS = 1.8 ms/mm Hg; AUC = 0.83). In patients with poor outcome, ICP and PRx increased while BRS remained low. CONCLUSIONS We found an association between temporal patterns of BRS and prognosis in the early days following TBI. Further research in a larger cohort of patients is needed to confirm the weight of these preliminary observations for prediction of prognosis in TBI patients.
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Martinez-Alanis M, Calderón-Juárez M, Martínez-García P, González Gómez GH, Infante O, Pérez-Grovas H, Lerma C. Baroreflex Sensitivity Assessment Using the Sequence Method with Delayed Signals in End-Stage Renal Disease Patients. SENSORS (BASEL, SWITZERLAND) 2022; 23:260. [PMID: 36616859 PMCID: PMC9823877 DOI: 10.3390/s23010260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Impaired baroreflex sensitivity (BRS) is partially responsible for erratic blood pressure fluctuations in End-Stage Renal Disease (ESRD) patients on chronic hemodialysis (HD), which is related to autonomic nervous dysfunction. The sequence method with delayed signals allows for the measurement of BRS in a non-invasive fashion and the investigation of alterations in this physiological feedback system that maintains BP within healthy limits. Our objective was to evaluate the modified delayed signals in the sequence method for BRS assessment in ESRD patients without pharmacological antihypertensive treatment and compare them with those of healthy subjects. We recruited 22 healthy volunteers and 18 patients with ESRD. We recorded continuous BP to obtain a 15-min time series of systolic blood pressure and interbeat intervals during the supine position (SP) and active standing (AS) position. The time series with delays from 0 to 5 heartbeats were used to calculate the BRS, number of data points, number of sequences, and estimation error. The BRS from the ESRD patients was smaller than in healthy subjects (p < 0.05). The BRS estimation with the delayed sequences also increased the number of data points and sequences and decreased the estimation error compared to the original time series. The modified sequence method with delayed signals may be useful for the measurement of baroreflex sensitivity in ESRD patients with a shorter recording time and maintaining an estimation error below 0.01 in both the supine and active standing positions. With this framework, it was corroborated that baroreflex sensitivity in ESRD is decreased when compared with healthy subjects.
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Affiliation(s)
| | - Martín Calderón-Juárez
- Plan de Estudios Combinados en Medicina, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
- Department of Electromechanical Instrumentation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 04480, Mexico
| | - Paola Martínez-García
- Servicio de Radioterapia y Física Médica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 04480, Mexico
| | | | - Oscar Infante
- Department of Electromechanical Instrumentation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 04480, Mexico
| | - Héctor Pérez-Grovas
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 04510, Mexico
| | - Claudia Lerma
- Department of Electromechanical Instrumentation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 04480, Mexico
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Salem AM, Yar T, Al Eid M, Almahfoudh H, Alsaffar M, Al Ibrahim A, Almadan A, Alaidarous S, Almulhim R, Rafique N, Latif R, Siddiqui IA, Alsunni A. Post-Acute Effect of SARS-CoV-2 Infection on the Cardiac Autonomic Function. Int J Gen Med 2022; 15:7593-7603. [PMID: 36204699 PMCID: PMC9531620 DOI: 10.2147/ijgm.s382331] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Ayad Mohammed Salem
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Correspondence: Ayad Mohammed Salem, Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, PO Box 2114-31451, Dammam, Saudi Arabia, Email
| | - Talay Yar
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed Al Eid
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Husain Almahfoudh
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed Alsaffar
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah Al Ibrahim
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ali Almadan
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sana Alaidarous
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Razan Almulhim
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nazish Rafique
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rabia Latif
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Intisar Ahmad Siddiqui
- Department of Dental Education, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed Alsunni
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Ethnic discrimination and depressed mood: The role of autonomic regulation. J Psychiatr Res 2021; 144:110-117. [PMID: 34619489 DOI: 10.1016/j.jpsychires.2021.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/09/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022]
Abstract
Perceived ethnic discrimination (PED) is thought to underlie increased prevalence of depressed mood in ethnic minorities. Depression is associated with increased sympathetic and decreased parasympathetic activity. We investigated a biopsychosocial model linking PED, disrupted sympathovagal balance and depressed mood. Baseline data of HELIUS, a cohort study on health among a multi-ethnic population, was used. Heart rate variability (HRV), baroreflex sensitivity (BRS), PED (evaluated with the Everyday Discrimination Scale) and presence of depressed mood (evaluated with the Patient Health Questionnaire-9) were assessed. Associations of PED, HRV/BRS and depressed mood were analyzed with linear and logistic regression analyses. Mediation of the association of PED and depressed mood by HRV/BRS was assessed in a potential outcomes model and four steps mediation analysis. Of 9492 included participants, 14.7% fulfilled criteria for depressed mood. Higher PED was associated with depressed mood (P < .001). Lower autonomic regulation indexes were associated with depressed mood (deltaR2 = 0.4-1.1%, P < .001) and at most weakly with PED (deltaR2 = 0.2-0.3%, P < .001). A very modest mediating effect by HRV/BRS in the association between PED and depressed mood was attenuated after adjustment for socioeconomic status. To conclude, we found no support for the hypothesis that autonomic regulation relevantly mediates the association between PED and depression.
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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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van Nieuwenhuizen BP, Sekercan A, Tan HL, Blom MT, Lok A, van den Born BJH, Kunst AE, van Valkengoed IGM. Is the Association Between Education and Sympathovagal Balance Mediated by Chronic Stressors? Int J Behav Med 2021; 29:426-437. [PMID: 34580830 PMCID: PMC9338002 DOI: 10.1007/s12529-021-10027-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
Background This study investigated whether raised chronic stress in low education groups contributes to education differences in cardiovascular disease by altering sympathovagal balance. Methods This study included cross-sectional data of 10,202 participants from the multi-ethnic, population-based HELIUS-study. Sympathovagal balance was measured by baroreflex sensitivity (BRS), the standard deviation of the inter-beat interval (SDNN) and the root mean square of successive differences between normal heartbeats (RMSSD). The associations between chronic stressors (work, home, psychiatric, financial, negative life events, lack of job control and perceived discrimination) in a variety of domains and BRS, SDNN and RMSSD were assessed using linear regression, adjusted for age, ethnicity, waist-to-hip ratio and pack-years smoked. Mediation analysis was used to assess the contribution of chronic stress to the association between education and sympathovagal balance. Results Modest but significant associations were observed between financial stress and BRS and SDNN in women, but not in RMSSD nor for any outcome measure in men. Women with the highest category of financial stress had 0.55% lower BRS (ms/mmHg; β = -0.055; CI = -0.098, -0.011) and 0.61% lower SDNN (ms; β = -0.061; CI = -0.099, -0.024) than those in the lowest category. Financial stress in women contributed 7.1% to the association between education and BRS, and 13.8% to the association between education and SDNN. Conclusion No evidence was found for the hypothesized pathway in which sympathovagal balance is altered by chronic stress, except for a small contribution of financial stress in women. Supplementary Information The online version contains supplementary material available at 10.1007/s12529-021-10027-9.
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Affiliation(s)
| | - Aydin Sekercan
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, OLVG, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Clinical and Experimental Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Marieke T Blom
- Department of Clinical and Experimental Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan H van den Born
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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12
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Kounoupis A, Dipla K, Tsabalakis I, Papadopoulos S, Galanis N, Boutou AK, Vrabas IS, Smilios I, Zafeiridis A. Muscle Oxygenation, Neural, and Cardiovascular Responses to Isometric and Workload-matched Dynamic Resistance Exercise. Int J Sports Med 2021; 43:119-130. [PMID: 34380149 DOI: 10.1055/a-1539-6561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Differences in blood flow patterns and energy cost between isometric and dynamic resistance exercise may result to variant cardiovascular, neural, and muscle metabolic responses. We aimed to compare the cardiovascular, baroreceptor sensitivity, and muscle oxygenation responses between workload-matched, large muscle-mass isometric and dynamic resistance exercises. Twenty-four young men performed an isometric and a dynamic double leg-press protocol (4 sets×2 min) with similar tension time index (workload). Beat-by-beat hemodynamics, baroreceptor sensitivity, muscle oxygenation, and blood lactate were assessed. The increase in blood pressure was greater (p<0.05) in the 1st set during dynamic than isometric exercise (by ~4.5 mmHg), not different in the 2nd and 3rd sets, and greater in the 4th set during isometric exercise (by ~5 mmHg). Dynamic resistance exercise evoked a greater increase in heart rate, stroke volume, cardiac output, and contractility index (p<0.05), and a greater decline in peripheral resistance, baroreceptor sensitivity, and cardiac function indices than isometric exercise (p<0.05). Participants exhibited a greater reduction in muscle oxyhemoglobin and a greater increase in muscle deoxyhemoglobin in dynamic versus isometric exercise (p<0.001-0.05), with no differences in total hemoglobin and blood lactate. In conclusion, large muscle-mass, multiple-set isometric exercise elicits a relatively similar blood pressure but blunted cardiovascular and baroreceptor sensitivity responses compared to workload-matched dynamic resistance exercise. Differences in blood pressure responses between protocols appear small (~5 mmHg) and are affected by the number of sets. The muscle oxidative stimulus is greater during dynamic resistance exercise than workload-matched isometric exercise.
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Affiliation(s)
- Anastasios Kounoupis
- Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Serres, Greece
| | - Konstantina Dipla
- Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Serres, Greece
| | - Ioannis Tsabalakis
- Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Serres, Greece
| | - Stavros Papadopoulos
- Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Serres, Greece
| | - Nikiforos Galanis
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi K Boutou
- Department of Respiratory Medicine, General Hospital of Thessaloniki G Papanikolaou, Thessaloniki, Greece
| | - Ioannis S Vrabas
- Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Serres, Greece
| | - Ilias Smilios
- Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | - Andreas Zafeiridis
- Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Serres, Greece
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13
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Cherouveim ED, Miliotis P, Dipla K, Koskolou MD, Vrabas IS, Geladas ND. The effect of muscle blood flow restriction on hemodynamics, cerebral oxygenation and activation at rest. Appl Physiol Nutr Metab 2021; 46:1216-1224. [PMID: 33951406 DOI: 10.1139/apnm-2020-1082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study tested the hypothesis that muscle blood flow restriction reduces muscle and cerebral oxygenation, at rest. In 26 healthy males, aged 33±2 yrs, physiological variables were continuously recorded during a 10-min period in two experimental conditions: a) with muscle blood flow restriction through thigh cuffs application inflated at 120 mmHg (With Cuffs, WC) and b) without restriction (No Cuffs, NC). Muscle and cerebral oxygenation were reduced by muscle blood flow restriction as suggested by the increase in both muscle and cerebral deoxygenated hemoglobin (Δ[HHb]; p<0.01) and the decrease of muscle and cerebral oxygenation index (Δ[HbDiff]; p<0.01). Hemodynamic responses were not affected by such muscle blood flow restriction, whereas baroreflex sensitivity was reduced (p=0.009). The perception of leg discomfort was higher (p<0.001) in the WC than in the NC condition. This study suggests that thigh cuffs application inflated at 120 mmHg is an effective method to reduce muscle oxygenation at rest. These changes at the muscular level seem to be sensed by the central nervous system, evoking alterations in cerebral oxygenation and baroreflex sensitivity. Novelty bullets: • Thigh cuffs application inflated at 120 mmHg effectively reduces muscle oxygenation at rest. • Limiting muscle oxygenation appears to reduce cerebral oxygenation, and baroreflex sensitivity, at rest. • Even in healthy subjects, limiting muscle oxygenation, at rest, affects neural integration.
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Affiliation(s)
- Evgenia D Cherouveim
- National and Kapodistrian University of Athens, 68993, School of Physical Education and Sport Science, Athens, Attica, Greece;
| | - Panagiotis Miliotis
- National and Kapodistrian University of Athens, 68993, School of Physical Education and Sport Science, Athens, Attica, Greece;
| | - Konstantina Dipla
- Aristotle University of Thessaloniki, Department of Physical Education and Sport Sciences at Serres (TEFAA), Exercise Physiology and Biochemistry Laboratory, Serres, Greece, 62110;
| | - Maria D Koskolou
- National and Kapodistrian University of Athens, 68993, School of Physical Education and Sport Science, Athens, Attica, Greece;
| | | | - Nickos D Geladas
- National and Kapodistrian University of Athens, 68993, School of Physical Education and Sport Science, Athens, Attica, Greece;
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Acampa M, Voss A, Bojić T. Editorial: Cardiorespiratory Coupling-Novel Insights for Integrative Biomedicine. Front Neurosci 2021; 15:671900. [PMID: 33897367 PMCID: PMC8058216 DOI: 10.3389/fnins.2021.671900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maurizio Acampa
- Stroke Unit, Department of Emergency-Urgency and Transplants, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General-Hospital, Siena, Italy
| | - Andreas Voss
- Institut für Innovative Gesundheitstechnologien (IGHT), Jena, Germany
| | - Tijana Bojić
- Laboratory for Radiobiology and Molecular Genetics-080, Institute of Nuclear Sciences Vinča-National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
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15
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Abstract
OBJECTIVE Alterations in sympathovagal balance are associated with cardiovascular disease. If sympathovagal balance differs across socioeconomic groups, it may reflect a mechanism through which disparities in cardiovascular disease occur. We therefore assessed the association between education and occupation with measures of sympathovagal balance in a large multiethnic sample. METHODS We included cross-sectional data of 10,202 South Asian Surinamese, African Surinamese, Ghanaian, Turkish, Moroccan, and Dutch-origin participants from the Healthy Life in an Urban Setting study. Sympathovagal balance was measured by baroreflex sensitivity (BRS) and the standard deviation of the interbeat interval, calculated from changes in blood pressure and interbeat intervals, from 5-minute recordings. We calculated geometric means and estimated the relative index of inequality, using age- and ethnicity-adjusted linear regression, to quantify the association between education and occupation and sympathovagal balance. In addition, we assessed whether the association was consistent across ethnic groups. RESULTS The geometric means of BRS ranged from 8.16 ms/mm Hg (confidence interval [CI] = 7.91-8.43 ms/mm Hg) in low-educated to 14.00 ms/mm Hg (CI = 13.53-14.48 ms/mm Hg) in highly educated women, and from 8.32 ms/mm Hg (CI, 7.97-8.69 ms/mm Hg) in low-educated to 12.25 ms/mm Hg (CI = 11.86-12.66 ms/mm Hg) in highly educated men. High education and occupation were statistically significantly associated with higher BRS and standard deviation of the interbeat interval. Compared with the participants of Dutch origin, a pattern of weaker associations was found in the Surinamese and Ghanaian ethnic groups, but not the Turkish and Moroccan groups. CONCLUSIONS There is a clear socioeconomic gradient in measures of sympathovagal balance, indicating that sympathovagal balance may play a role in socioeconomic disparities in cardiovascular morbidity and mortality.
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Karemaker JM. Interpretation of Heart Rate Variability: The Art of Looking Through a Keyhole. Front Neurosci 2020; 14:609570. [PMID: 33408610 PMCID: PMC7779618 DOI: 10.3389/fnins.2020.609570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022] Open
Abstract
The heart may be a mirror of the soul, but the human mind is more than its heart rate variability (HRV). Many techniques to quantify HRV promise to give a view of what is going on in the body or even the psyche of the subject under study. This "Hypothesis" paper gives, on the one hand, a critical view on the field of HRV-analysis and, on the other hand, points out a possible direction of future applications. In view of the inherent variability of HRV and the underlying processes, as lined out here, the best use may be found in serial analysis in a subject/patient, to find changes over time that may help in early discovery of developing pathology. Not every future possibility is bright and shining, though, as demonstrated in a fictional diary excerpt from a future subject, living in a society geared toward preventive medicine. Here implanted biochips watch over the health of the population and artificial intelligence (AI) analyses the massive data flow to support the diagnostic process.
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Affiliation(s)
- John M. Karemaker
- Department of Medical Biology, Section Systems Physiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
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17
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Shah Z, Pal P, Pal GK, Papa D, Bharadwaj B. Assessment of the association of heart rate variability and baroreflex sensitivity with depressive symptoms and stress experienced by women in pregnancy. J Affect Disord 2020; 277:503-509. [PMID: 32882507 DOI: 10.1016/j.jad.2020.08.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pregnancy is a unique physiological state with systemic changes including cardiovascular, autonomic, hemodynamic and psychological. Increase in incidence of stress and depression in antenatal period has been reported. Autonomic changes in pregnancy and its dysfunction in depression are well documented. However, there is lack of evidence associating cardiovascular autonomic dysfunction to stress and depressed mood in pregnant women. METHODS In this correlation study, we assessed cardiovascular autonomic functions of 172 pregnant women using heart rate variability (HRV) and baroreflex sensitivity (BRS). The Edinburg postnatal depression scale (EPDS) was used to evaluate depressive symptoms and perceived stress scale (PSS) was used to assess stress. The HRV and BRS parameters were correlated with EPDS and PSS. Multiple regression analysis was performed for EPDS and PSS individually to study their association with cardiac autonomic functions(CAF). RESULTS HRV and BRS were well correlated to EPDS and PSS scores. The depression and stress were found to be significantly associated to autonomic dysfunctions as increased sympathetic and decreased parasympathetic activity. Among various CAF parameters, LF:HF ratio and BRS were found to be significantly associated with depression and stress among these women. CONCLUSION LF:HF ratio and BRS may be associated with depression during antenatal period. The depression in antenatal period may add on to cardiovascular risk in expecting mothers.
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Affiliation(s)
- Zinkal Shah
- Department of Physiology, JIPMER, Puducherry 605006, India
| | - Pravati Pal
- Department of Physiology, JIPMER, Puducherry 605006, India.
| | | | - Dasari Papa
- Department of Obstetrics and Gynecology, JIPMER, Puducherry, India
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18
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AlShahrani AN, Al‐Asoom LI, Alsunni AA, Elbahai NS, Yar T. Assessment of baroreceptor reflex sensitivity in young obese Saudi males at rest and in response to physiological challenges. Physiol Rep 2020; 8:e14625. [PMID: 33190394 PMCID: PMC7666776 DOI: 10.14814/phy2.14625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022] Open
Abstract
Autonomic imbalance in overweight/obese persons could lead to an increased risk of cardiovascular complications including hypertension and arrhythmias. Baroreceptor reflex sensitivity is a sensitive indicator to detect an altered sympathovagal balance in overweight/obese individuals. This study investigated the effects of overweight/obesity on baroreceptor sensitivity in young Saudi males at rest and in response to physiological challenges. SUBJECTS AND METHODS In this cross-sectional study, spontaneous baroreceptor sensitivity at rest and in response to deep breathing, isometric hand grip exercise and moderate intensity isotonic exercise were recorded in 20 normal weight and 20 overweight/obese subjects. Finger arterial blood pressure signal, recorded through Finometer, was used to calculate baroreceptor sensitivity through cross-correlation method. The baroreceptor sensitivity data were log transformed before application of parametric tests. RESULTS The spontaneous baroreceptor sensitivity was similar in both groups at baseline, but exhibited a significant increase during deep breathing only in normal weight (p < .001). Immediately after the isotonic exercise the baroreceptor sensitivity was significantly lower than baseline in both normal weight and overweight/obese and remained significantly lower in overweight/obese individuals compared to normal weight (p < .05) throughout the recovery period. There was a significant rise in baroreceptor sensitivity after isometric exercise in overweight/obese group only (p = .001). Pearson's correlation showed a significant negative correlation of baroreceptor sensitivity with body mass index during deep breathing (r = -.472, p = .004) and in post-isotonic exercise recovery period (r = -.414, p = .013). CONCLUSION A significantly reduced baroreceptor sensitivity response to deep breathing, reduced baroreceptor sensitivity recovery after isotonic exercise, and an exaggerated shoot up after isometric exercise in overweight/obese suggests an altered sympathovagal balance. Baroreceptor sensitivity measurements in response to physiological challenges, deep breathing, and isotonic exercise, may be more sensitive investigations for detection of early attenuation of cardiac autonomic function. This would enable timely intervention thereby delaying complications and improving the quality of life.
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Affiliation(s)
- Abdullah N. AlShahrani
- Department of PhysiologyCollege of MedicineImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Lubna I. Al‐Asoom
- Department of PhysiologyCollege of MedicineImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Ahmed A. Alsunni
- Department of PhysiologyCollege of MedicineImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Nabil S. Elbahai
- Department of PhysiologyCollege of MedicineImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Talay Yar
- Department of PhysiologyCollege of MedicineImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
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19
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Wessel N, Gapelyuk A, Weiß J, Schmidt M, Kraemer JF, Berg K, Malberg H, Stepan H, Kurths J. Instantaneous Cardiac Baroreflex Sensitivity: xBRS Method Quantifies Heart Rate Blood Pressure Variability Ratio at Rest and During Slow Breathing. Front Neurosci 2020; 14:547433. [PMID: 33071732 PMCID: PMC7543095 DOI: 10.3389/fnins.2020.547433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/04/2020] [Indexed: 11/13/2022] Open
Abstract
Spontaneous baroreflex sensitivity (BRS) is a widely used tool for the quantification of the cardiovascular regulation. Numerous groups use the xBRS method, which calculates the cross-correlation between the systolic beat-to-beat blood pressure and the R-R interval (resampled at 1 Hz) in a 10 s sliding window, with 0-5 s delays for the interval. The delay with the highest correlation is selected and, if significant, the quotient of the standard deviations of the R-R intervals and the systolic blood pressures is recorded as the corresponding xBRS value. In this paper we test the hypothesis that the xBRS method quantifies the causal interactions of spontaneous BRS from non-invasive measurements at rest. We use the term spontaneous BRS in the sense of the sensitivity curve is calculated from non-interventional, i.e., spontaneous, baroreceptor activity. This study includes retrospective analysis of 1828 measurements containing ECG as well as continues blood pressure under resting conditions. Our results show a high correlation between the heart rate - systolic blood pressure variability (HRV/BPV) quotient and the xBRS (r = 0.94, p < 0.001). For a deeper understanding we conducted two surrogate analyses by substituting the systolic blood pressure by its reversed time series. These showed that the xBRS method was not able to quantify causal relationships between the two signals. It was not possible to distinguish between random and baroreflex controlled sequences. It appears xBRS rather determines the HRV/BPV quotient. We conclude that the xBRS method has a potentially large bias in characterizing the capacity of the arterial baroreflex under resting conditions. During slow breathing, estimates for xBRS are significantly increased, which clearly shows that measurements at rest only involve limited baroreflex activity, but does neither challenge, nor show the full range of the arterial baroreflex regulatory capacity. We show that xBRS is exclusively dominated by the heart rate to systolic blood pressure ratio (r = 0.965, p < 0.001). Further investigations should focus on additional autonomous testing procedures such as slow breathing or orthostatic testing to provide a basis for a non-invasive evaluation of baroreflex sensitivity.
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Affiliation(s)
- Niels Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrej Gapelyuk
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jonas Weiß
- Institute of Biomedical Engineering, Technische Universität Dresden, Dresden, Germany
| | - Martin Schmidt
- Institute of Biomedical Engineering, Technische Universität Dresden, Dresden, Germany
| | - Jan F Kraemer
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Karsten Berg
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hagen Malberg
- Institute of Biomedical Engineering, Technische Universität Dresden, Dresden, Germany
| | - Holger Stepan
- Division of Obstetrics, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Jürgen Kurths
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany.,Potsdam Institute for Climate Impact Research, Potsdam, Germany.,Department of Human and Animal Physiology, Saratov State University, Saratov, Russia
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20
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Bakema MJ, van Zuiden M, Collard D, Zantvoord JB, de Rooij SR, Elsenburg LK, Snijder MB, Stronks K, van den Born BJH, Lok A. Associations Between Child Maltreatment, Autonomic Regulation, and Adverse Cardiovascular Outcome in an Urban Population: The HELIUS Study. Front Psychiatry 2020; 11:69. [PMID: 32256391 PMCID: PMC7092011 DOI: 10.3389/fpsyt.2020.00069] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/27/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION A mounting body of literature emphasizes the potential negative effects of adverse childhood experiences (ACEs) on both mental and physical health throughout life, including an increased risk for developing cardiovascular disease (CVD). Since CVD is one of the leading causes of mortality and morbidity worldwide, it is of great importance to advance our understanding of the effects of on CVD. This holds both for the actual incidence and for intermediate biological pathways that may convey CVD risk, such as imbalance in autonomic nervous system regulation, resulting in a chronically heightened sympathetic activity and lowered reactivity. In a large urban, multi-ethnic population-based cohort study we investigated whether there is an association between child maltreatment, CVD incidence and autonomic regulation. METHODS Within the Health in an Urban Setting (HELIUS) study, a large, multi-ethnic population cohort study including n = 22,165 Amsterdam residents, we used logistic regression analyses to investigate the association between the number of self-reported types of child maltreatment (range 0-4), and self-reported adverse cardiovascular outcome (aCVO). Self-reported child maltreatment included emotional neglect, emotional abuse, physical abuse, and sexual abuse. Furthermore, in a subsample (n = 10,260), mean age 44.3, we investigated associations between child maltreatment, autonomic regulation, and aCVO using linear regression analyses. Both baroreflex sensitivity (BRS) and heart rate variability (HRV) were assessed as non-invasive indices of autonomic regulation. RESULTS The number of endorsed child maltreatment types was significantly associated with a higher aCVO risk. The association remained significant after adjustment for demographic, socioeconomic, health-behavioral, and psychological covariates (p = 0.011, odds ratio: 1.078, confidence interval: 1.018-1.142). The cumulative exposure to child maltreatment was negatively associated with BRS and HRV, but the association was no longer significant after correction for socioeconomic and demographic covariates. CONCLUSION In a large, multi-ethnic urban-population cohort study we observed a positive association between number of endorsed child maltreatment types and self-reported aCVO but not autonomic regulation, over and above the effect of relevant demographic, health, and psychological factors. Future studies should examine the potential role of the dynamics of autonomic dysregulation as potential underlying biological pathways in the association between ACEs and CVD, as this could eventually facilitate the development of preventive and therapeutic strategies for CVD.
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Affiliation(s)
- Maryse J. Bakema
- Department of Psychiatry, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mirjam van Zuiden
- Department of Psychiatry, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Didier Collard
- Department of Internal and Vascular Medicine, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jasper B. Zantvoord
- Department of Psychiatry, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Susanne R. de Rooij
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Leonie K. Elsenburg
- Department of Public Health, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marieke B. Snijder
- Department of Internal and Vascular Medicine, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Karien Stronks
- Department of Public Health, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Bert-Jan H. van den Born
- Department of Internal and Vascular Medicine, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands
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de Boer RW, Karemaker JM. Cross-Wavelet Time-Frequency Analysis Reveals Sympathetic Contribution to Baroreflex Sensitivity as Cause of Variable Phase Delay Between Blood Pressure and Heart Rate. Front Neurosci 2019; 13:694. [PMID: 31338017 PMCID: PMC6629771 DOI: 10.3389/fnins.2019.00694] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction Baroreflex sensitivity (BRS) is often presented as a single number, but it is actually a frequency-dependent phenomenon whose value changes constantly due to internal and external stimuli. The standing posture, for instance, necessitates a changeover from vagal to sympathetic predominance for cardiovascular control. We present a wavelet cross-spectral analysis of blood pressure (BP) and interbeat interval (IBI) recordings in the search for variations in gain and phase between these signals. Additionally, we show how the lag in sympathetic response dictates BP-to-IBI phase relations. Methods Recordings in supine and head-up tilted (HUT) position, obtained earlier in 10 healthy subjects (4f/6m, aged 27–47 years) were used. BP and IBI were measured from the continuous finger pressure (by Finometer). The cross-wavelet analysis produced time- and frequency dependent gain (wBRS, wavelet derived BRS) and phase, using the MATLAB® wavelet toolbox. We also applied the wBRS method to model-generated BP- and IBI-data with known interrelations to test the results of this analysis technique. Finally, wBRS values were compared with the xBRS-approach, which is a time domain method for continuous BRS estimation in a sliding 10-s window. Results In resting supine conditions, wBRS fluctuates; more at respiratory frequencies than in the 0.1 Hz band. After HUT, wBRS at the respiratory frequency decreases from average 22.7 to 8.5 ms/mmHg, phase between BP and IBI increases from −30° to −54°; in the sympathetic 0.1 Hz range these numbers are 13.3→6.3 ms/mmHg and −54°→−59°. The values found by xBRS are intermediate between wBRS-resp and wBRS-0.1 Hz. The Appendix shows that for the simulated data the BRS and phase values as found by the wavelet technique can be explained from vector additions of vagal and sympathetic BRS contributions. Discussion During supine rest parasympathetic control of heart rate dominates BRS; after HUT this is diminished and less effective. Due to the reaction times of the autonomic effectors, the phase relations between the signals depend on the relative contribution of the sympathetics, which explains the larger phase shift. Conclusion Cross wavelet analysis allows to follow fast BRS changes in time and frequency, while the computed phase relations help understand sympathetic participation.
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Affiliation(s)
- Roel W de Boer
- Department of Medical Biology, Section Systems Physiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
| | - John M Karemaker
- Department of Medical Biology, Section Systems Physiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
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Turcani M, Ghadhanfar E. Biphasic changes in spontaneous cardiovagal baroreflex sensitivity during passive hyperthermia. Sci Rep 2019; 9:2586. [PMID: 30796280 PMCID: PMC6385277 DOI: 10.1038/s41598-019-39172-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/18/2019] [Indexed: 01/28/2023] Open
Abstract
Successful adaptation to passive hyperthermia requires continual adjustment of circulation, which is mediated mainly by the autonomic nervous system. The goal of this study was to explore the alterations in spontaneous cardiovagal baroreflex sensitivity (BRS) during exposure to a hot environment. To continuously follow changes in core body temperature (Tc), haemodynamics, and BRS, male Wistar-Kyoto rats were implanted with telemetric transmitters. BRS at an ambient temperature of 23 °C was not steady but oscillated with a maximum power in the range of 0.02–0.2 Hz. Exposure to hot air immediately shifted the distribution of BRS to higher values, although Tc remained unchanged (37.2 (0.3) °C), and the average BRS changed from 1.3 (0.3) to 3 (1.4) ms.mmHg−1, p < 0.0001. The degree of initial cardiovagal baroreflex sensitization explained 57% of the variability in the time to the onset of arterial pressure decline (p = 0.0114). With an increasing Tc (>38.8 (0.6) °C), BRS non-linearly declined, but haemodynamic parameters remained stable even above a Tc of 42 °C when the cardiovagal baroreflex was virtually non-operative. Abrupt full desensitization of the cardiovagal baroreflex with a muscarinic blocker did not induce arterial pressure decline. Our data indicate that a progressive decrease in BRS during passive hyperthermia does not induce haemodynamic instability. The positive association between initial cardiovagal baroreflex sensitization and the time to the onset of arterial pressure decline may reflect the potential protective role of parasympathetic activation during exposure to a hot environment.
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Affiliation(s)
- Marian Turcani
- Department of Physiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, Safat, 13110, Kuwait.
| | - Elham Ghadhanfar
- Department of Physiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, Safat, 13110, Kuwait
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Baroreflex Impairment After Subarachnoid Hemorrhage Is Associated With Unfavorable Outcome. Stroke 2018; 49:1632-1638. [DOI: 10.1161/strokeaha.118.020729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/26/2018] [Accepted: 05/03/2018] [Indexed: 11/16/2022]
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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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