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Yu TY, Hong W, Jin S, Hur KY, Jee JH, Bae JC, Kim JH, Lee M. Delayed heart rate recovery after exercise predicts development of metabolic syndrome: A retrospective cohort study. J Diabetes Investig 2022; 13:167-176. [PMID: 34313016 PMCID: PMC8756310 DOI: 10.1111/jdi.13637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS/INTRODUCTION Several cross-sectional studies have shown that delayed heart rate recovery (HRR) after exercise is associated with the development of metabolic syndrome (MetS). However, there has been a lack of comprehensively designed longitudinal studies. Therefore, our aim was to evaluate the longitudinal association of delayed HRR following a graded exercise treadmill test (GTX) with incident MetS. MATERIALS AND METHODS This was a retrospective longitudinal cohort study of participants without MetS, diabetes, or cardiovascular diseases. The HRR was calculated as the peak heart rate minus the resting heart rate after a 1 min rest (HRR1), a 2 min rest (HRR2), and a 3 min rest (HRR3). Multivariate Cox proportional hazards analysis was performed to investigate the association between HRR and development of MetS. RESULTS There were 676 (31.2%) incident cases of MetS identified during the follow-up period (9,683 person-years). The only statistically significant relationship was between HRR3 and the development of MetS. The hazard ratios (HRs) (95% confidence interval [CI]) of incident MetS comparing the first and second tertiles to the third tertile of HRR3 were 1.492 (1.146-1.943) and 1.277 (1.004-1.624) with P = 0.003 after adjustment for multiple risk factors. As a continuous variable, the HR (95% CI) of incident MetS associated with each one-beat decrease in HRR3 was 1.015 (1.005-1.026) with P = 0.004 after full adjustments. An HRR3 value ≤45 beats per minute (bpm) was associated with a higher risk of incident MetS compared with values >45 bpm, with an HR (95% CI) of 1.304 (1.061-1.602) and P = 0.001. CONCLUSIONS The slow phase of HRR, particularly HRR3, might be more sensitive at predicting the risk of MetS.
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Affiliation(s)
- Tae Yang Yu
- Division of Endocrinology and MetabolismDepartment of MedicineWonkwang Medical CenterWonkwang University School of MedicineIksanKorea
- Department of MedicineSungkyunkwan University Graduate School of MedicineSeoulKorea
| | - Won‐Jung Hong
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Sang‐Man Jin
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Kyu Yeon Hur
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Jae Hwan Jee
- Department of Health Promotion CenterSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Ji Cheol Bae
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Changwon HospitalSungkyunkwan University School of MedicineChangwonKorea
| | - Jae Hyeon Kim
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Moon‐Kyu Lee
- Division of Endocrinology and MetabolismDepartment of Internal MedicineUijeongbu Eulji Medical CenterEulji University School of MedicineUijeongbuKorea
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Itagi ABH, Jayalakshmi MK, Yunus GY. Effect of obesity on cardiovascular responses to submaximal treadmill exercise in adult males. J Family Med Prim Care 2020; 9:4673-4679. [PMID: 33209782 PMCID: PMC7652132 DOI: 10.4103/jfmpc.jfmpc_543_20] [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: 04/04/2020] [Revised: 04/26/2020] [Accepted: 05/20/2020] [Indexed: 11/06/2022] Open
Abstract
Context: Obesity is a major risk factor for chronic diseases. Abnormal changes in cardiovascular responses to exercise indicate the alteration in autonomic activity in obese. Aims: To assess and compare the cardiovascular parameters before and after exercise among obese and nonobese adult males. Subjects and Methods: Thirty each obese and normal-weight males between the age group 18-45 years were selected as cases and controls, respectively. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), corrected QT intervals were measured before and after submaximal treadmill exercise (QT and QTc) were done according to Bruce protocol. HR, SBP, DBP, MAP, QT, and QTc were also measured during passive recovery at 1 min and 5 min after exercise. Statistical Analysis Used: One-way analysis of variance and t-test were used to assess changes before and after exercise. Results: Resting HR was significantly higher in obese when compared to nonobese (P < 0.05). SBP, DBP, MAP, QT, and QTc were significantly higher in obese when compared to nonobese (P < 0.001). Immediately after exercise HR, SBP, DBP, MAP, QT, and QTc were significantly higher in obese when compared to nonobese (P < 0.001) 1 min after exercise. Conclusions: Obese individuals had elevated resting cardiovascular parameters and showed increased responses to steady exercise which could be due to alteration in autonomic functions with sympathetic hyperactivity. Delayed rate of decrease in HR and BP after exercise was also observed in obese, which indicates that they are at risk of developing cardiovascular diseases.
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Affiliation(s)
- Afreen Begum H Itagi
- Department of Physiology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - M K Jayalakshmi
- Department of Physiology, Gadag Institute of Medical Sciences, Gadag, Karnataka, India
| | - G Y Yunus
- Department of of Public Health Dentistry, Aditya Dental College, Beed, Maharashtra, India
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Fernández-Miranda G, Romero-Garcia T, Barrera-Lechuga TP, Mercado-Morales M, Rueda A. Impaired Activity of Ryanodine Receptors Contributes to Calcium Mishandling in Cardiomyocytes of Metabolic Syndrome Rats. Front Physiol 2019; 10:520. [PMID: 31114513 PMCID: PMC6503767 DOI: 10.3389/fphys.2019.00520] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/11/2019] [Indexed: 01/11/2023] Open
Abstract
Metabolic syndrome (MetS) has become a global epidemic. MetS is a serious health problem because of its related cardiovascular complications, which include hypertension and delayed heart rate recovery after exercise. The molecular bases of cardiac dysfunction in MetS are still under scrutiny and may be related to anomalies in the activity and expression of key proteins involved in the cardiac excitation-contraction coupling (ECC). The cardiac Ca2+ channel/ryanodine receptor (RyR2) participates in releasing Ca2+ from internal stores and plays a key role in the modulation of ECC. We examined alterations in expression, phosphorylation status, Ca2+ sensitivity, and in situ function (by measuring Ca2+ sparks and Ca2+ transients) of RyR2; alterations in these characteristics could help to explain the Ca2+ handling disturbances in MetS cardiomyocytes. MetS was induced in rats by adding commercially refined sugar (30% sucrose) to their drinking water for 24 weeks. Cardiomyocytes of MetS rats displayed decreased Ca2+ transient amplitude and cell contractility at all stimulation frequencies. Quiescent MetS cardiomyocytes showed a decrease in Ca2+ spark frequency, amplitude, and spark-mediated Ca2+ leak. The [3H]-ryanodine binding data showed that functionally active RyRs are significantly diminished in MetS heart microsomes; and exhibited rapid Ca2+-induced inactivation. The phosphorylation of corresponding Ser2814 (a preferential target for CaMKII) of the hRyR2 was significantly diminished. RyR2 protein expression and Ser2808 phosphorylation level were both unchanged. Further, we demonstrated that cardiomyocyte Ca2+ mishandling was associated with reduced SERCA pump activity due to decreased Thr17-PLN phosphorylation, suggesting a downregulation of CaMKII in MetS hearts, though the SR Ca2+ load remained unchanged. The reduction in the phosphorylation level of RyR2 at Ser2814 decreases RyR2 availability for activation during ECC. In conclusion, the impaired in situ activity of RyR2 may also account for the poor overall cardiac outcome reported in MetS patients; hence, the SERCA pump and RyR2 are both attractive potential targets for future therapies.
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Affiliation(s)
- Gaudencio Fernández-Miranda
- Departamento de Bioquímica, Centro de Investigación y de Estudios Avanzados del IPN (CINVESTAV), Mexico City, Mexico
| | - Tatiana Romero-Garcia
- Departamento de Bioquímica, Centro de Investigación y de Estudios Avanzados del IPN (CINVESTAV), Mexico City, Mexico
| | - Tarín P Barrera-Lechuga
- Departamento de Bioquímica, Centro de Investigación y de Estudios Avanzados del IPN (CINVESTAV), Mexico City, Mexico
| | - Martha Mercado-Morales
- Departamento de Bioquímica, Centro de Investigación y de Estudios Avanzados del IPN (CINVESTAV), Mexico City, Mexico
| | - Angélica Rueda
- Departamento de Bioquímica, Centro de Investigación y de Estudios Avanzados del IPN (CINVESTAV), Mexico City, Mexico
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Relation of Exercise Heart Rate Recovery to Predict Cardiometabolic Syndrome in Men. Am J Cardiol 2019; 123:582-587. [PMID: 30527776 DOI: 10.1016/j.amjcard.2018.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/03/2018] [Accepted: 11/07/2018] [Indexed: 11/22/2022]
Abstract
We examined the hypothesis that delayed heart rate recovery (HRR) after exercise testing, an estimate of decreased autonomic function, predicts the risk of cardiometabolic syndrome (MetS) and is associated with continuous MetS risk scores in healthy men. Participants were 2,740 men who underwent general health examinations and had no evidence of MetS, cardiovascular diseases, diabetes, and hypertension at baseline. Baseline HRR was calculated as the difference between peak heart rate attained during exercise testing and the heart rate at 1 (HRR 1) and 2 minutes (HRR 2) after test termination. Incident MetS was defined as participants having ≥3 MetS components, and continuous MetS risk score was computed as the sum of z-score of 5 risk factors at follow-up. The incidence of MetS was 61/1,000 person-years during an average follow-up of 5 years. The relative risks and 95% confidence interval (CI) of incident MetS in the lowest quartiles of HRR 1 and HRR 2 versus the highest quartile were 1.24 (95% CI 1.02 to 1.51) and 2.02 (95% CI 1.58 to 2.60), respectively, after adjusting for potential confounders, including peak oxygen uptake and resting heart rate. HRR 1 (ß = -0.052, p = 0.005) and HRR 2 (ß = -0.058, p = 0.009) were independently associated with clustered MetS risk scores after adjusting for covariates. In conclusion, the independent association between delayed HRR after exercise testing and incident MetS and continuous MetS risk scores suggests that decreased autonomic function may be considered as a parameter to predict the future likelihood of MetS.
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Bjelakovic L, Vukovic V, Jovic M, Bankovic S, Kostic T, Radovanovic D, Pantelic S, Zivkovic M, Stojanovic S, Bjelakovic B. Heart rate recovery time in metabolically healthy and metabolically unhealthy obese children. PHYSICIAN SPORTSMED 2017; 45:438-442. [PMID: 28885093 DOI: 10.1080/00913847.2017.1376571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Autonomic dysfunction is an emerging non-traditional cardiovascular risk factor that correlates with obesity, components of metabolic syndrome, as well as cardiorespiratory fitness. As a simple and validated index of autonomic balance, heart rate recovery (HRR) has been reported as a useful biomarker for predicting cardiovascular morbidity and mortality. OBJECTIVES The aim of this study was to compare HRR in metabolically healthy vs. metabolically unhealthy obese children. METHODS A total of 56 obese children of whom 31 had metabolic syndrome were examined. All the participants underwent the multistage submaximal cycle ergometer test and HRR was determined one minute after the test. RESULTS The HRR was significantly lower (18.9 ± 3.7) in a group of metabolically unhealthy obese children compared to metabolically healthy obese children (24 ± 4.1) p < 0.001. Logistic regression analysis showed that reduction in HRR was also influenced by higher BMI. CONCLUSION Our findings implicate the presence of the autonomic dysfunction as reflected by impaired heart rate recovery (HRR) in obese children with metabolic syndrome.
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Affiliation(s)
- Ljiljana Bjelakovic
- a Department of medical science, Faculty of Sport and Physical Education , University of Nis , Nis , Serbia
| | - Vladimir Vukovic
- b Department of Molecular Medicine , Universita Cattolica del Sacro Cuore , Rome , Italy
| | - Marko Jovic
- c Medical faculty , University of Nis , Nis , Serbia
| | | | - Tomislav Kostic
- c Medical faculty , University of Nis , Nis , Serbia.,d Clinic of Cardiology , Clinical Center Nis , Nis , Serbia
| | - Dragan Radovanovic
- a Department of medical science, Faculty of Sport and Physical Education , University of Nis , Nis , Serbia
| | - Sasa Pantelic
- e Faculty of Sport and Physical Education , University of Nis , Nis , Serbia
| | - Mladen Zivkovic
- e Faculty of Sport and Physical Education , University of Nis , Nis , Serbia
| | - Sanja Stojanovic
- f Niska Banja, Medical Faculty University of Nis , Institute of cardiology , Nis , Serbia
| | - Bojko Bjelakovic
- c Medical faculty , University of Nis , Nis , Serbia.,g Clinic of Pediatrics , Clinical Center , Nis , Serbia
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Sexual dimorphism in heart rate recovery from peak exercise. Eur J Appl Physiol 2017; 117:1373-1381. [PMID: 28470411 DOI: 10.1007/s00421-017-3627-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE There is lack of consensus on whether sex, per se, affects heart rate recovery (HRR). To discriminate between the role of sex and that of cardiovascular fitness on HRR, we compared two groups of male and female participants matched for age and peak oxygen uptake (VO2peak) percentile. METHODS Forty healthy individuals with above-average cardiovascular fitness (VO2peak >50th percentile), aged 18-27 years (23 men; 17 women), performed maximal cycle-ergometer tests with cardiorespiratory measurements. HRR was obtained at 1 and 2 min of passive recovery. Multiple linear regression analysis was used to determine whether the relationship between VO2peak and HRR differed between sexes. RESULTS Men attained greater peak values for VO2 and work rate (p < 0.05). Both groups of participants exhibited similar heart rate response to peak exercise and no sex differences were observed in VO2peak percentile or ventilatory threshold. HRR at 1 and 2 min of passive recovery was similar between sexes. In multiple linear models, VO2peak explained 11.2% of the variance in HRR1min both in men and women (p < 0.05). Most importantly, sex, VO2peak, and their interaction were all significant predictors of HRR2min (explained variance 29.2%) (p < 0.05). CONCLUSIONS This study shows that, for a given VO2peak percentile (>50th percentile), there is no sexual dimorphism in HRR obtained at 1 or 2 min of recovery. It also demonstrates that, in persons with similar VO2peak values, HRR obtained at 2 min of peak exercise cessation is affected by sex.
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Horsley KJ, Rouleau CR, Garland SN, Samuels C, Aggarwal SG, Stone JA, Arena R, Campbell TS. Insomnia symptoms and heart rate recovery among patients in cardiac rehabilitation. J Behav Med 2016; 39:642-51. [PMID: 26944765 DOI: 10.1007/s10865-016-9725-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/04/2016] [Indexed: 01/26/2023]
Abstract
Insomnia symptoms (i.e., difficulty falling asleep, difficulty staying asleep, and early morning awakenings) are common among people with cardiovascular disease, and have been linked to adverse cardiovascular health outcomes. Reduced parasympathetic tone is one pathway through which risk may be conferred. The purpose of this study was to evaluate whether insomnia symptoms are associated with lower parasympathetic tone in cardiac rehabilitation patients with suspected insomnia. Participants (N = 121) completed a self-report measure of insomnia severity. 1-min heart rate recovery (HRR), an index of parasympathetic tone, was obtained during a maximal exercise test. Difficulty falling asleep, but not difficulty staying asleep or early awakenings, was associated with attenuated 1-min HRR. When analyses were restricted to participants with moderate and severe insomnia severity (n = 51), the strength of this association increased. In a sample of cardiac rehabilitation patients with insomnia, only the symptom of difficulty falling asleep was associated with lower parasympathetic tone, suggesting that individual insomnia symptoms may show specificity in their associations with physiological mechanisms.
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Affiliation(s)
| | - Codie R Rouleau
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Sheila N Garland
- Department of Psychology, Memorial University, St. John's, NL, Canada
| | - Charles Samuels
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Sandeep G Aggarwal
- TotalCardiology™ Rehabilitation, Calgary, AB, Canada.,Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - James A Stone
- TotalCardiology™ Rehabilitation, Calgary, AB, Canada.,Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada.
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Chang YM, Shiao CC, Huang YT, Chen IL, Yang CL, Leu SC, Su HL, Kao JL, Tsai SC, Jhen RN, Uen CC. Impact of metabolic syndrome and its components on heart rate variability during hemodialysis: a cross-sectional study. Cardiovasc Diabetol 2016; 15:16. [PMID: 26817599 PMCID: PMC4729144 DOI: 10.1186/s12933-016-0328-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/04/2016] [Indexed: 12/02/2022] Open
Abstract
Background Both uremia and metabolic syndrome (MetS) affect heart rate variability (HRV) which is a risk factor of poor prognoses. The aim of this study was to evaluate the impact of MetS on HRV among chronic hemodialysis patients. Methods This cross-sectional study was carried out in a teaching hospital in Northern Taiwan from June to August, 2010. Adult patients on chronic hemodialysis without active medical conditions were enrolled. HRV were measured for 4 times on the index hemodialysis day (HRV-0, -1, -2, and -3 at before, initial, middle, and late phases of hemodialysis, respectively), and the baseline demographic data and clinical parameters during the hemodialysis session were documented. Then we evaluated the impacts of MetS and its five components on HRV. Results One hundred and seventy-five patients (100 women, mean age 65.1 ± 12.9 years) were enrolled and included those with MetS (n = 91, 52 %) and without MetS (n = 84, 48 %). The patients with MetS(+) had significantly lower very low frequency, total power, and variance in HRV-0, total power and variance in HRV-2, and variance in HRV-3. (all p ≦ 0.05) When using the individual components of MetS to evaluate the impacts on HRV indices, the fasting plasma glucose (FPG) criterion significantly affected most indices of HRV while other four components including “waist circumference”, “triglycerides”, “blood pressure”, and “high-density lipoprotein” criteria exhibited little impacts on HRV. FPG criterion carried the most powerful influence on cardiac ANS, which was even higher than that of MetS. The HRV of patients with FPG(+) increased initially during the hemodialysis, but turned to decrease dramatically at the late phase of hemodialysis. Conclusions The impact of FPG(+) outstood the influence of uremic autonomic dysfunction, and FPG criterion was the most important one among all the components of MetS to influence HRV. These results underscored the importance of interpretation and management for abnormal glucose metabolism.
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Affiliation(s)
- Yu-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC
| | - Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC. .,Saint Mary's Medicine, Nursing and Management College, No. 100, Ln. 265, Sec. 2, Sanxing Rd., Sanxing Township, Yilan County, 266, Taiwan, ROC.
| | - Ya-Ting Huang
- Department of Nursing, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 33302, Taiwan, ROC
| | - I-Ling Chen
- Department of Nursing, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC
| | - Chuan-Lan Yang
- Department of Nursing, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC
| | - Show-Chin Leu
- Department of Nursing, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC
| | - Hung-Li Su
- Department of Nursing, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC
| | - Jsun-Liang Kao
- Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC
| | - Shih-Ching Tsai
- Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC
| | - Rong-Na Jhen
- Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC
| | - Ching-Cherng Uen
- Division of Neurology, Department of Internal Medicine, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC
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Cepeda FX, Toschi-Dias E, Maki-Nunes C, Rondon MUPB, Alves MJNN, Braga AMFW, Martinez DG, Drager LF, Lorenzi-Filho G, Negrao CE, Trombetta IC. Obstructive Sleep Apnea Impairs Postexercise Sympathovagal Balance in Patients with Metabolic Syndrome. Sleep 2015; 38:1059-66. [PMID: 25669187 DOI: 10.5665/sleep.4812] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 12/18/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES The attenuation of heart rate recovery after maximal exercise (ΔHRR) is independently impaired by obstructive sleep apnea (OSA) and metabolic syndrome (MetS). Therefore, we tested the hypotheses: (1) MetS + OSA restrains ΔHRR; and (2) Sympathetic hyperactivation is involved in this impairment. DESIGN Cross-sectional study. PARTICIPANTS We studied 60 outpatients in whom MetS had been newly diagnosed (ATP III), divided according to apnea-hypopnea index (AHI) ≥ 15 events/h in MetS + OSA (n = 30, 49 ± 1.7 y) and AHI < 15 events/h in MetS - OSA (n = 30, 46 ± 1.4 y). Normal age-matched healthy control subjects (C) without MetS and OSA were also enrolled (n = 16, 46 ± 1.7 y). INTERVENTIONS Polysomnography, microneurography, cardiopulmonary exercise test. MEASUREMENTS AND RESULTS We evaluated OSA (AHI - polysomnography), muscle sympathetic nerve activity (MSNA - microneurography) and cardiac autonomic activity (LF = low frequency, HF = high frequency, LF/HF = sympathovagal balance) based on spectral analysis of heart rate (HR) variability. ΔHRR was calculated (peak HR minus HR at first, second, and fourth minute of recovery) after cardiopulmonary exercise test. MetS + OSA had higher MSNA and LF, and lower HF than MetS - OSA and C. Similar impairment occurred in MetS - OSA versus C (interaction, P < 0.01). MetS + OSA had attenuated ΔHRR at first, second, and at fourth minute than did C, and attenuated ΔHRR at fourth minute than did MetS - OSA (interaction, P < 0.001). Compared with C, MetS - OSA had attenuated ΔHRR at second and fourth min (interaction, P < 0.001). Further analysis showed association of the ΔHRR (first, second, and fourth minute) and AHI, MSNA, LF and HF components (P < 0.05 for all associations). CONCLUSIONS The attenuation of heart rate recovery after maximal exercise is impaired to a greater degree where metabolic syndrome (MetS) is associated with moderate to severe obstructive sleep apnea (OSA) than by MetS with no or mild or no OSA. This is at least partly explained by sympathetic hyperactivity.
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Affiliation(s)
- Felipe X Cepeda
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Edgar Toschi-Dias
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Cristiane Maki-Nunes
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Maria Urbana P B Rondon
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.,School of Physical Education and Sports, University of São Paulo, São Paulo, Brazil
| | | | - Ana Maria F W Braga
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel G Martinez
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Luciano F Drager
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | - Carlos E Negrao
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.,School of Physical Education and Sports, University of São Paulo, São Paulo, Brazil
| | - Ivani C Trombetta
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.,Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
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Relation of heart rate recovery after exercise to insulin resistance and chronic inflammation in otherwise healthy adolescents and adults: results from the National Health and Nutrition Examination Survey (NHANES) 1999–2004. Clin Res Cardiol 2015; 104:764-72. [DOI: 10.1007/s00392-015-0843-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/11/2015] [Indexed: 11/27/2022]
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11
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Alihanoglu YI, Yildiz BS, Kilic ID, Uludag B, Demirci EE, Zungur M, Evrengul H, Kaftan AH. Impaired systolic blood pressure recovery and heart rate recovery after graded exercise in patients with metabolic syndrome. Medicine (Baltimore) 2015; 94:e428. [PMID: 25590851 PMCID: PMC4602554 DOI: 10.1097/md.0000000000000428] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to evaluate and compare systolic blood pressure recovery and heart rate recovery (HRR) values obtained at various time intervals after maximal graded exercise treadmill testing between patients with metabolic syndrome (MS) and the controls without MS. To our knowledge, this is the first study indicating systolic blood pressure recovery (SBPR) impairment and its relations to HRR and other variables in this group of patients. The study population included 110 patients with MS (67 men, 43 women; mean age: 46 ± 9 years) and 110 control subjects who did not meet the criteria for MS (58 men, 52 women; mean age: 44 ± 10 years). All patients were selected from nonobese, apparently healthy sedentary individuals who had the ability to perform maximum exercise testing. SBPR was assessed by calculating the ratio of systolic blood pressure (SBP) obtained in the third minute of the recovery period to either the peak-exercise SBP or the SBP in the first minute of the recovery period after graded exercise testing. HRR values were calculated by subtracting the HR at the first, second, third, fourth, and fifth minutes of the recovery period from the HR reached at peak exercise. There was no significant difference found between the 2 groups with respect to age and sex distribution. As expected, patients with MS had higher waist circumference, fasting plasma glucose and serum triglyceride, and lower high-density lipoprotein cholesterol compared with control subjects. All HRR values calculated in the first, second, third, fourth, and fifth minutes were significantly detected lower in the MS group compared with the control group (HRR 1st: 32 ± 10 vs 36 ± 11; P = 0.009; HRR 2nd: 47 ± 10 vs 51 ± 11; P = 0.02; HRR 3rd: 53 ± 11 vs 58 ± 12; P = 0.001; HRR 4th: 57 ± 11 vs 64 ± 12; P < 0.001; HRR 5th: 60 ± 16 vs 69 ± 15; P < 0.001). In addition, calculated mean values for SBPR1 and SBPR2 were >1 in patients with MS (1.01 ± 0.2 vs 0.91 ± 0.1 and 1.01 ± 0.1 vs 0.94 ± 0.1) and these were statistically significant compared with the control group (P < 0.001 and P = 0.002, respectively). The existence of MS was found to be the only parameter that was independently and positively related to SBPR values in the study population. Our findings suggest that only the existence of MS itself, not the presence of any MS components, is independently associated with SBPRs. We are of the opinion that significantly impaired SBPR values, in addition to the decreased HRR values observed in this group of patients, such as those with MS, may especially help identify patients with potentially increased cardiovascular risk despite normal exercise stress testing findings.
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Affiliation(s)
- Yusuf I Alihanoglu
- From the Department of Cardiology (YIA, BSY, IDK, BU, EED, HE, AHK), Medical Faculty, Pamukkale University, Denizli; and Department of Cardiology (MZ), Medical Faculty, Sifa University, Izmir, Turkey
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Gentile C, Dragomir AI, Solomon C, Nigam A, D’Antono B. Sex Differences in the Prediction of Metabolic Burden from Physiological Responses to Stress. Ann Behav Med 2014; 49:112-27. [DOI: 10.1007/s12160-014-9639-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Peçanha T, Silva-Júnior ND, Forjaz CLDM. Heart rate recovery: autonomic determinants, methods of assessment and association with mortality and cardiovascular diseases. Clin Physiol Funct Imaging 2013; 34:327-39. [DOI: 10.1111/cpf.12102] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 10/14/2013] [Indexed: 01/24/2023]
Affiliation(s)
- Tiago Peçanha
- Exercise Hemodynamic Laboratory; School of Physical Education and Sport; University of Sao Paulo; São Paulo Brazil
| | - Natan Daniel Silva-Júnior
- Exercise Hemodynamic Laboratory; School of Physical Education and Sport; University of Sao Paulo; São Paulo Brazil
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Okutucu S, Karakulak UN, Aytemir K, Oto A. Heart rate recovery: a practical clinical indicator of abnormal cardiac autonomic function. Expert Rev Cardiovasc Ther 2012; 9:1417-30. [PMID: 22059791 DOI: 10.1586/erc.11.149] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The autonomic nervous system (ANS) and cardiovascular function are intricately and closely related. One of the most frequently used diagnostic and prognostic tools for evaluating cardiovascular function is the exercise stress test. Exercise is associated with increased sympathetic and decreased parasympathetic activity and the period of recovery after maximum exercise is characterized by a combination of sympathetic withdrawal and parasympathetic reactivation, which are the two main arms of the ANS. Heart rate recovery after graded exercise is one of the commonly used techniques that reflects autonomic activity and predicts cardiovascular events and mortality, not only in cardiovascular system disorders, but also in various systemic disorders. In this article, the definition, applications and protocols of heart rate recovery and its value in various diseases, in addition to exercise physiology, the ANS and their relationship, will be discussed.
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Affiliation(s)
- Sercan Okutucu
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
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Kim J, Byun W, Sui X, Lee DC, Cheng YJ, Blair SN. Heart rate recovery after treadmill exercise testing is an independent predictor of stroke incidence in men with metabolic syndrome. Obes Res Clin Pract 2011; 5:e267-360. [DOI: 10.1016/j.orcp.2011.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 02/24/2011] [Accepted: 03/21/2011] [Indexed: 11/27/2022]
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Effect of heart-rate recovery on long-term mortality among men and women. Int J Cardiol 2010; 144:276-9. [DOI: 10.1016/j.ijcard.2009.01.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 01/26/2009] [Indexed: 11/19/2022]
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Nagashima J, Musha H, Takada H, Takagi K, Mita T, Mochida T, Yoshihisa T, Imagawa Y, Matsumoto N, Ishige N, Fujimaki R, Nakajima H, Murayama M. Three-month exercise and weight loss program improves heart rate recovery in obese persons along with cardiopulmonary function. J Cardiol 2010; 56:79-84. [DOI: 10.1016/j.jjcc.2010.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 02/04/2010] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
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Straznicky NE, Lambert GW, Lambert EA. Neuroadrenergic dysfunction in obesity: an overview of the effects of weight loss. Curr Opin Lipidol 2010; 21:21-30. [PMID: 19809312 DOI: 10.1097/mol.0b013e3283329c62] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW The prevalence of obesity is rising to epidemic proportions worldwide, and in tandem so is that of type 2 diabetes. Neuroadrenergic abnormalities, comprising increased resting sympathetic nervous system activity and blunted sympathetic neural responsiveness are recognized features of metabolic syndrome obesity, which contribute importantly to both the pathophysiology and adverse clinical prognosis of this high-risk population. Weight loss is recommended as first-line treatment for obesity. This review examines the effects of nonpharmacological weight loss on sympathetic nervous system function under basal and stimulated conditions. RECENT FINDINGS Human weight loss trials show that even moderate weight reduction is accompanied by significant attenuation in resting whole-body norepinephrine spillover rate and muscle sympathetic nerve activity, an improvement in cardiac autonomic modulation, and a reversal of blunted sympathetic responsiveness at both peripheral and central nervous system levels. Recent findings underscore the relevance of insulin resistance in mediating blunted sympathetic responsiveness to endogenous hyperinsulinemia induced by glucose ingestion. Impaired insulin transport across the blood-brain barrier may be one mechanism mediating these effects. Weight loss reverses blunted sympathetic responsiveness to glucose, which has implications for postprandial energy expenditure and body weight homeostasis. SUMMARY The autonomic dysfunction of obesity is reversible with weight loss, highlighting the importance of lifestyle intervention as a key therapeutic modality.
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Affiliation(s)
- Nora E Straznicky
- Human Neurotransmitters Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia.
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Arena R, Arrowood JA, Fei D, Shelar S, Helm S, Kraft KA. The influence of sex on the relationship between heart rate recovery and other cardiovascular risk factors in apparently healthy subjects. Scand J Med Sci Sports 2009; 20:291-7. [DOI: 10.1111/j.1600-0838.2009.00883.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Giallauria F, Orio F, Lombardi G, Colao A, Vigorito C, Tafuri MG, Palomba S. Relationship between heart rate recovery and inflammatory markers in patients with polycystic ovary syndrome: a cross-sectional study. J Ovarian Res 2009; 2:3. [PMID: 19187547 PMCID: PMC2646730 DOI: 10.1186/1757-2215-2-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 02/02/2009] [Indexed: 01/01/2023] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is an endocrine disease closely related to several risk factors for cardiovascular disease. An abnormal heart rate recovery (HRR), an easily-obtained measure derived from exercise stress test and closely related to an increased risk for cardiovascular mortality, has been recently described in PCOS women. A subclinical increase of the inflammation markers has been also observed in the PCOS. This study was designed to study the relationships between HRR and inflammatory markers in PCOS women. Methods Two-hundred forty-three young PCOS patients without known risk factors for cardiovascular risk were enrolled. All patients underwent hormonal and metabolic profile, white blood cells (WBCs) count and C-reactive protein (CRP). HRR was calculated as the difference between heart rate at peak exercise and heart rate at first minute of the cool-down period. Abnormal HRR was defined as ≤18 beats/min for standard exercise testing. Results Eighty-nine out of 243 patients presented abnormal HRR. Serum CRP (1.8 ± 0.7 vs. 1.1 ± 0.4 mg/dl, p < 0.001) and WBCs (7.3 ± 1.8 vs. 6.6 ± 1.5 109 cells/l, p < 0.001) concentrations were significantly higher in PCOS patients with abnormal versus normal HRR. HRR was significantly associated with both CRP (r = -0.33, p < 0.001) and WBCs (r = -0.29, p < 0.001), although in a stepwise multiple regression HRR resulted independently associated with CRP (beta = -0.151, p = 0.001) alone. In a logistic multivariate model, the group within the highest quartile of CRP (odds ratio 1.59, 95% CI 1.07–2.33) was more likely to have abnormal HRR than those within the lowest quartile. Conclusion Abnormal HRR and inflammatory markers are closely associated in PCOS women acting probably in concert to increase the cardiovascular risk profile of these patients.
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Affiliation(s)
- Francesco Giallauria
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Cardiac Rehabilitation Unit, University of Naples "Federico II", Naples, Italy.
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Abstract
The metabolic syndrome represents a major public health burden because of its high prevalence in the general population and its association with cardiovascular disease and type 2 diabetes. Accumulated evidence based on biochemical, neurophysiologic, and indirect measurements of autonomic activity indicate that visceral obesity and the metabolic syndrome are associated with enhanced sympathetic neural drive and vagal impairment. The mechanisms linking metabolic syndrome with sympathetic activation are complex and not completely understood, and cause-effect relationships need further clarification from prospective trials. Components of the metabolic syndrome that may directly or indirectly enhance sympathetic drive include hyperinsulinemia, leptin, nonesterified fatty acids, proinflammatory cytokines, angiotensinogen, baroreflex impairment, and obstructive sleep apnea. beta-Adrenoceptor polymorphisms have also been associated with adrenoceptor desensitization, increased adiposity, insulin resistance, and enhanced sympathetic activity. Because chronic sympathetic activation contributes to hypertension and its target-organ damage, sympathoinhibition remains an important goal in the therapeutic management of the metabolic syndrome.
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Maeder MT, Ammann P, Rickli H, Brunner-La Rocca HP. Impact of the exercise mode on heart rate recovery after maximal exercise. Eur J Appl Physiol 2008; 105:247-55. [DOI: 10.1007/s00421-008-0896-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2008] [Indexed: 10/21/2022]
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Nilsson G, Hedberg P, Jonason T, Lönnberg I, Ohrvik J. Heart rate recovery is more strongly associated with the metabolic syndrome, waist circumference, and insulin sensitivity in women than in men among the elderly in the general population. Am Heart J 2007; 154:460.e1-7. [PMID: 17719290 DOI: 10.1016/j.ahj.2007.06.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 06/19/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Low heart rate recovery (HRR) at exercise test and the metabolic syndrome (MetS) are both predictors of cardiovascular morbidity and mortality. We studied in 75-year-old women and men, representative of the general population, the relationship between (1) HRR and the MetS, (2) HRR and the individual components of the MetS, and (3) HRR and insulin sensitivity. METHODS A cross-sectional study of randomly selected 75-year-olds from a general population was performed (191 women and 194 men). The MetS was defined according to the National Cholesterol Education Program criteria. Heart rate was measured as beats per minute immediately after exercise and at 4 minutes into recovery. RESULTS Heart rate recovery (median and interquartile range, beat/min) was 48 (37-58) for women and 49 (38-58) for men. Thirty-seven percent of the women and 25% of the men had the MetS. Heart rate recovery was 52 (42-61) for women with the MetS and 42 (31-49) for those without. The corresponding values for men was 50 (39-61) and 47 (35-54); the difference between individuals with and without the MetS was significant for women (P < .001) but not for men (P = .084). The following significant correlation coefficients between HRR and MetS components were found: for women, waist circumference (-0.43, P < .001), high-density lipoprotein cholesterol (0.37, P < .001), insulin sensitivity (-0.37, P < .001), fasting plasma glucose (-0.30, P < .001), and triglycerides (-0.24, P = .001); for men, triglycerides (-0.20, P = .005). The sex disparity in the strength of correlation reached statistical significance for insulin sensitivity (P < .001) and waist circumference (P = .042). CONCLUSION Among 75-year-olds, the MetS and related components are more strongly correlated to HRR in women than in men.
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Affiliation(s)
- Göran Nilsson
- Department of Medicine, Central Hospital, Västerås, Sweden
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