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Takeda R, Hissen SL, Akins JD, Washio T, Hearon CM, MacNamara JP, Sarma S, Levine BD, Fadel PJ, Fu Q. Sympathetic Neural Control at Rest and During the Cold Pressor Test in Patients With Heart Failure With Preserved Ejection Fraction. Hypertension 2024; 81:917-926. [PMID: 38385250 PMCID: PMC10954398 DOI: 10.1161/hypertensionaha.123.21918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND We tested the hypothesis that patients with heart failure with preserved ejection fraction (HFpEF) would have greater muscle sympathetic nerve activity (MSNA) at rest and sympathetic reactivity during a cold pressor test compared with non-heart failure controls. Further, given the importance of the baroreflex modulation of MSNA in the control of blood pressure (BP), we hypothesized that patients with HFpEF would exhibit a reduced sympathetic baroreflex sensitivity. METHODS Twenty-eight patients with HFpEF and 44 matched controls (mean±SD: 71±8 versus 70±7 years; 9 men/19 women versus 16 men/28 women) were studied. BP, heart rate, and MSNA (microneurography) were measured during 6 to 10 minutes of supine rest and the 2-minute cold pressor test. Spontaneous sympathetic baroreflex sensitivity was assessed during supine rest. RESULTS Patients with HFpEF had higher resting MSNA burst frequency (39±14 versus 31±12 bursts/min; P=0.020) and lower sympathetic baroreflex sensitivity (-2.83±0.76 versus -3.57±1.19 bursts/100 heartbeats/mm Hg; P=0.019) than controls, but burst incidence was not different between groups (56±19 versus 50±20 bursts/100 heartbeats; P=0.179). During the cold pressor test, increases in MSNA indices did not differ between groups (P=0.135-0.998), but patients had a smaller increase in diastolic BP (Δ4±6 versus Δ14±11 mm Hg; P<0.001) compared with controls. CONCLUSIONS Despite augmented resting MSNA burst frequency, burst incidence was not significantly different between groups, and sympathetic baroreflex sensitivity was reduced in patients with HFpEF. Furthermore, patients had preserved sympathetic reactivity but attenuated diastolic BP responses during the cold pressor test. These data suggest that, during physiological stress, sympathetic reactivity is intact, but the peripheral pathway for sympathetic vasoconstriction may be impaired in HFpEF.
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Affiliation(s)
- Ryosuke Takeda
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah L. Hissen
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - John D. Akins
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Takuro Washio
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christopher M. Hearon
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James P. MacNamara
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin D. Levine
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Paul J. Fadel
- University of Texas at Arlington, Arlington, Texas, USA
| | - Qi Fu
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Washio T, Hissen SL, Takeda R, Akins JD, Wakeham DJ, Brazile T, Hearon CM, MacNamara JP, Sarma S, Levine BD, Fadel PJ, Fu Q. Potential for reducing resting sympathetic nerve activity with new classes of glucose-lowering drugs in heart failure with preserved ejection fraction. Clin Auton Res 2024; 34:223-226. [PMID: 38285071 PMCID: PMC11031183 DOI: 10.1007/s10286-023-01013-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024]
Affiliation(s)
- Takuro Washio
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Ste. 435, Dallas, TX, 75231-8205, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah L Hissen
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Ste. 435, Dallas, TX, 75231-8205, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ryosuke Takeda
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Ste. 435, Dallas, TX, 75231-8205, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John D Akins
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Ste. 435, Dallas, TX, 75231-8205, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Denis J Wakeham
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Ste. 435, Dallas, TX, 75231-8205, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tiffany Brazile
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Ste. 435, Dallas, TX, 75231-8205, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christopher M Hearon
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Ste. 435, Dallas, TX, 75231-8205, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James P MacNamara
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Ste. 435, Dallas, TX, 75231-8205, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Ste. 435, Dallas, TX, 75231-8205, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Ste. 435, Dallas, TX, 75231-8205, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Paul J Fadel
- University of Texas at Arlington, Arlington, TX, USA
| | - Qi Fu
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Ste. 435, Dallas, TX, 75231-8205, USA.
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Ando S, Tsukamoto H, Stacey BS, Washio T, Owens TS, Calverley TA, Fall L, Marley CJ, Iannetelli A, Hashimoto T, Ogoh S, Bailey DM. Acute hypoxia impairs posterior cerebral bioenergetics and memory in man. Exp Physiol 2023; 108:1516-1530. [PMID: 37898979 PMCID: PMC10988469 DOI: 10.1113/ep091245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023]
Abstract
Hypoxia has the potential to impair cognitive function; however, it is still uncertain which cognitive domains are adversely affected. We examined the effects of acute hypoxia (∼7 h) on central executive (Go/No-Go) and non-executive (memory) tasks and the extent to which impairment was potentially related to regional cerebral blood flow and oxygen delivery (CDO2 ). Twelve male participants performed cognitive tasks following 0, 2, 4 and 6 h of passive exposure to both normoxia and hypoxia (12% O2 ), in a randomized block cross-over single-blinded design. Middle cerebral artery (MCA) and posterior cerebral artery (PCA) blood velocities and corresponding CDO2 were determined using bilateral transcranial Doppler ultrasound. In hypoxia, MCA DO2 was reduced during the Go/No-Go task (P = 0.010 vs. normoxia, main effect), and PCA DO2 was attenuated during memorization (P = 0.005 vs. normoxia) and recall components (P = 0.002 vs. normoxia) in the memory task. The accuracy of the memory task was also impaired in hypoxia (P = 0.049 vs. normoxia). In contrast, hypoxia failed to alter reaction time (P = 0.19 vs. normoxia) or accuracy (P = 0.20 vs. normoxia) during the Go/No-Go task, indicating that selective attention and response inhibition were preserved. Hypoxia did not affect cerebral blood flow or corresponding CDO2 responses to cognitive activity (P > 0.05 vs. normoxia). Collectively, these findings highlight the differential sensitivity of cognitive domains, with memory being selectively vulnerable in hypoxia. NEW FINDINGS: What is the central question of this study? We sought to examine the effects of acute hypoxia on central executive (selective attention and response inhibition) and non-executive (memory) performance and the extent to which impairments are potentially related to reductions in regional cerebral blood flow and oxygen delivery. What is the main finding and its importance? Memory was impaired in acute hypoxia, and this was accompanied by a selective reduction in posterior cerebral artery oxygen delivery. In contrast, selective attention and response inhibition remained well preserved. These findings suggest that memory is selectively vulnerable to hypoxia.
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Affiliation(s)
- Soichi Ando
- Graduate School of Informatics and EngineeringThe University of Electro‐CommunicationsTokyoJapan
| | - Hayato Tsukamoto
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
- Faculty of Sports ScienceWaseda UniversitySaitamaJapan
| | - Benjamin S. Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Takuro Washio
- Department of Biomedical EngineeringToyo UniversityKawagoeSaitamaJapan
| | - Thomas S. Owens
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Thomas A. Calverley
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Lewis Fall
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Christopher J. Marley
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Angelo Iannetelli
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | | | - Shigehiko Ogoh
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
- Department of Biomedical EngineeringToyo UniversityKawagoeSaitamaJapan
| | - Damian M. Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
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D'Souza AW, Hissen SL, Manabe K, Washio T, Annis MC, Sanchez B, Fu Q, Shoemaker JK. Effects of biological sex and oral contraception on the sympathetic neurocirculatory adjustments to static handgrip exercise in humans. Am J Physiol Regul Integr Comp Physiol 2023; 325:R629-R644. [PMID: 37694305 DOI: 10.1152/ajpregu.00147.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/14/2023] [Accepted: 09/02/2023] [Indexed: 09/12/2023]
Abstract
While biological sex affects the neurocirculatory adjustments to exercise, the effects of sex hormones on sympathetic action potential (AP) patterns and ensuing vascular transduction remain unknown. We tested the hypothesis that males, and females using oral contraceptive pills (OCPs), would demonstrate larger increases in sympathetic activation and sympathetic vascular transduction compared with naturally menstruating females during static handgrip exercise (SHG) and postexercise circulatory occlusion (PECO). Young males [n = 14, 25 (5) yr], females using OCPs [n = 16, 24 (6) yr], and naturally menstruating females [n = 18, 26 (4) yr] underwent assessments of multiunit muscle sympathetic nerve activity (MSNA)/AP discharge patterns (microneurography) and femoral artery blood flow (ultrasound) during fatiguing SHG at 40% maximum voluntary contraction and 2-min PECO. Sympathetic vascular transduction was determined as the quotient of the change in leg vascular conductance (LVC) and MSNA/AP discharge. Males demonstrated greater increases in APs/burst [males: Δ7 (6) vs. midluteal: Δ2 (3), P = 0.028] and total AP clusters [males: Δ5 (3) vs. midluteal: Δ2 (3), P = 0.008] compared with naturally menstruating females only but not those using OCPs during exercise (APs/burst: P = 0.171, total clusters: P = 0.455). Sympathetic vascular transduction of MSNA burst amplitude, APs/burst, and total AP clusters was greater in males and females using OCPs compared with naturally menstruating females (range: P = 0.004-0.044). In contrast, during PECO no group differences were observed in AP discharge (range: P = 0.510-0.872), and AP discharge was not related to LVC during PECO (range: P = 0.08-0.949). These data indicate that biological sex and OCP use impact the central generation of AP discharge, as well as the transduction of these neuronal messages into peripheral vasoconstriction during static exercise.
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Affiliation(s)
- Andrew W D'Souza
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
- Women's Heart Health Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Sarah L Hissen
- Women's Heart Health Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kazumasa Manabe
- Women's Heart Health Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Takuro Washio
- Women's Heart Health Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Meghan C Annis
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
| | - Belinda Sanchez
- Women's Heart Health Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Qi Fu
- Women's Heart Health Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - J Kevin Shoemaker
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
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5
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D'Souza AW, Hissen SL, Manabe K, Takeda R, Washio T, Coombs GB, Sanchez B, Fu Q, Shoemaker JK. Age- and sex-related differences in sympathetic vascular transduction and neurohemodynamic balance in humans. Am J Physiol Heart Circ Physiol 2023; 325:H917-H932. [PMID: 37594483 DOI: 10.1152/ajpheart.00301.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/19/2023]
Abstract
Bursts of muscle sympathetic nerve activity (MSNA) and the ensuing vasoconstriction are pivotal determinants of beat-by-beat blood pressure regulation. Although age and sex impact blood pressure regulation, how these factors affect the central and peripheral arcs of the baroreflex remains unclear. In 27 young [25 (SD 3) yr] males (YM; n = 14) and females (YF; n = 13) and 23 older [71 (SD 5) yr] males (OM; n = 11) and females (OF; n = 12), femoral artery blood flow, blood pressure, and MSNA were recorded for 10 min of supine rest. Sympathetic baroreflex sensitivity (i.e., central arc) was quantified as the relationship between diastolic blood pressure and MSNA burst incidence. Signal averaging was used to determine sympathetic vascular transduction into leg vascular conductance (LVC) for 12 cardiac cycles following MSNA bursts (i.e., peripheral arc). Older adults demonstrated attenuated sympathetic transduction into LVC (both P < 0.001) following MSNA bursts, and smaller increases in sympathetic transduction as a function of MSNA burst size and firing pattern compared with young adults (range, P = 0.004-0.032). YM (r2 = 0.36; P = 0.032) and OM (r2 = 0.51; P = 0.014) exhibited an inverse relationship between the central and peripheral arcs of the baroreflex, whereas females did not (YF, r2 = 0.03, P = 0.621; OF, r2 = 0.06, P = 0.445). MSNA burst incidence was inversely related to sympathetic transduction in YM and OF (range, P = 0.03-0.046) but not in YF or OM (range, P = 0.360-0.603). These data indicate that age is associated with attenuated sympathetic vascular transduction, whereas age- and sex-specific changes are present in the relationship between the central and peripheral arcs of the baroreflex regulation of blood pressure.NEW & NOTEWORTHY Sympathetic vascular transduction is attenuated in older compared with young adults, regardless of biological sex. Males, but not females (regardless of age), demonstrate an inverse relationship between central (sympathetic baroreflex sensitivity) and peripheral (sympathetic vascular transduction) components of the baroreflex arc. Young males and older females exhibit an inverse relationship between resting sympathetic outflow and sympathetic vascular transduction. Our results indicate that age and sex exert independent and interactive effects on sympathetic vascular transduction and sympathetic neurohemodynamic balance in humans.
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Affiliation(s)
- Andrew W D'Souza
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
| | - Sarah L Hissen
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kazumasa Manabe
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Ryosuke Takeda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Sciences, Chukyo University, Toyota, Japan
| | - Takuro Washio
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Geoff B Coombs
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
| | - Belinda Sanchez
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - J Kevin Shoemaker
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
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Saveko A, Washio T, Petersen LG, Custaud MA, Liphardt AM. Corrigendum: Editorial: Rising stars in environmental, aviation and space physiology: 2022. Front Physiol 2023; 14:1250744. [PMID: 37501929 PMCID: PMC10369780 DOI: 10.3389/fphys.2023.1250744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fphys.2023.1230752.].
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Affiliation(s)
- Alina Saveko
- Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Takuro Washio
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, United States
- The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Lonnie G. Petersen
- Harvard-MIT Health Sciences and Technology, Cambridge, MA, United States
| | - Marc-Antoine Custaud
- CRC, CHU Angers, Inserm, CNRS, MITOVASC, SFR ICAT, University of Angers, Angers, France
| | - Anna-Maria Liphardt
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Úniversitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Úniversitätsklinikum Erlangen, Erlangen, Germany
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D'Souza AW, Takeda R, Manabe K, Hissen SL, Washio T, Coombs GB, Sanchez B, Fu Q, Shoemaker JK. The interactive effects of age and sex on the neuro-cardiovascular responses during fatiguing rhythmic handgrip exercise. J Physiol 2023; 601:2877-2898. [PMID: 37083007 DOI: 10.1113/jp284517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
The impact of age on exercise pressor responses is equivocal, likely because of sex-specific neuro-cardiovascular changes with age. However, assessments of the interactive effects of age and sex on muscle sympathetic nerve activity (MSNA) responses to exercise are lacking. We tested the hypothesis that older females would exhibit exaggerated increases in blood pressure (BP) and MSNA discharge patterns during handgrip exercise compared with similarly aged males and young adults. Twenty-five young (25 (2) years; mean (SD)) males (YM; n = 12) and females (YF; n = 13) and 23 older (71 (5) years) males (OM; n = 11) and females (OF; n = 12) underwent assessments of BP, total peripheral resistance (TPR; Modelflow) and MSNA action potential (AP) discharge patterns (microneurography) during incremental rhythmic handgrip exercise and post-exercise circulatory occlusion (PECO). OM demonstrated larger ∆BP and ∆TPR from baseline than YM (both P < 0.001) despite smaller increases in ∆APs/burst (OM: 0.4 (3) vs. YM: 5 (3) spikes/burst, P < 0.001) and ∆AP clusters/burst (OM: 0.1 (1) vs. YM: 1.8 (1) clusters/burst, P < 0.001) during exercise. Testosterone was lower in OM than YM (P < 0.001) and was inversely related to ∆BP but positively related to ∆AP clusters/burst in males (both P = 0.03). Conversely, YF and OF demonstrated similar ∆BP and ∆AP discharge during exercise (range: P = 0.75-0.96). Age and sex did not impact haemodynamics or AP discharge during PECO (range: P = 0.08-0.94). Altogether, age-related changes in neuro-cardiovascular reactivity exist in males but not females during fatiguing exercise and seem to be related to testosterone. This sex-specific impact of age underscores the importance of considering biological sex when assessing age-related changes in neuro-cardiovascular control during exercise. KEY POINTS: Older males have the largest increase in blood pressure despite having the smallest increases in sympathetic vasomotor outflow during rhythmic handgrip exercise. Young males demonstrate greater increases in sympathetic action potential (AP) discharge compared with young females during rhythmic handgrip exercise. Older adults (regardless of sex) demonstrate smaller increases in muscle sympathetic nerve activity (MSNA) burst amplitude and total AP clusters compared with young adults during exercise, as well as smaller increases in integrated MSNA burst frequency, incidence and total MSNA activity during post-exercise circulatory occlusion (i.e. independent effect of age). Males, but not females (regardless of age), reflexively modify AP conduction velocity during exercise. Our results indicate that age and sex independently and interactively impact the neural and cardiovascular homeostatic adjustments to fatiguing small muscle mass exercise.
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Affiliation(s)
- Andrew W D'Souza
- Neurovascular research laboratory, School of Kinesiology, Western University, London, Ontario, Canada
| | - Ryosuke Takeda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kazumasa Manabe
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah L Hissen
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Takuro Washio
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Geoff B Coombs
- Neurovascular research laboratory, School of Kinesiology, Western University, London, Ontario, Canada
| | - Belinda Sanchez
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - J Kevin Shoemaker
- Neurovascular research laboratory, School of Kinesiology, Western University, London, Ontario, Canada
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
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Saveko A, Washio T, Petersen LG, Custaud MA, Liphardt AM. Editorial: Rising stars in environmental, aviation and space physiology: 2022. Front Physiol 2023; 14:1230752. [PMID: 37351257 PMCID: PMC10284606 DOI: 10.3389/fphys.2023.1230752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023] Open
Affiliation(s)
- Alina Saveko
- Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Takuro Washio
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, United States
- The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Lonnie G. Petersen
- Harvard-MIT Health Sciences and Technology, Cambridge, MA, United States
| | - Marc-Antoine Custaud
- CRC, CHU Angers, Inserm, CNRS, MITOVASC, SFR ICAT, University of Angers, Angers, France
| | - Anna-Maria Liphardt
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Úniversitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Úniversitätsklinikum Erlangen, Erlangen, Germany
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Washio T, Hissen SL, Takeda R, Manabe K, Akins JD, Sanchez B, D'Souza AW, Nelson DB, Khan S, Tomlinson AR, Babb TG, Fu Q. Effects of posture changes on dynamic cerebral autoregulation during early pregnancy in women with obesity and/or sleep apnea. Clin Auton Res 2023; 33:121-131. [PMID: 37115467 DOI: 10.1007/s10286-023-00939-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/28/2023] [Indexed: 04/29/2023]
Abstract
The incidence of syncope during orthostasis increases in early human pregnancy, which may be associated with cerebral blood flow (CBF) dysregulation in the upright posture. In addition, obesity and/or sleep apnea per se may influence CBF regulation due to their detrimental impacts on cerebrovascular function. However, it is unknown whether early pregnant women with obesity and/or sleep apnea could have impaired CBF regulation in the supine position and whether this impairment would be further exacerbated in the upright posture. Dynamic cerebral autoregulation (CA) was evaluated using transfer function analysis in 33 women during early pregnancy (13 with obesity, 8 with sleep apnea, 12 with normal weight) and 15 age-matched nonpregnant women during supine rest. Pregnant women also underwent a graded head-up tilt (30° and 60° for 6 min each). We found that pregnant women with obesity or sleep apnea had a higher transfer function low-frequency gain compared with nonpregnant women in the supine position (P = 0.026 and 0.009, respectively) but not normal-weight pregnant women (P = 0.945). Conversely, the transfer function low-frequency phase in all pregnancy groups decreased during head-up tilt (P = 0.001), but the phase was not different among pregnant groups (P = 0.180). These results suggest that both obesity and sleep apnea may have a detrimental effect on dynamic CA in the supine position during early pregnancy. CBF may be more vulnerable to spontaneous blood pressure fluctuations in early pregnant women during orthostatic stress compared with supine rest due to less efficient dynamic CA, regardless of obesity and/or sleep apnea.
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Affiliation(s)
- Takuro Washio
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah L Hissen
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ryosuke Takeda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kazumasa Manabe
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John D Akins
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Belinda Sanchez
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
| | - Andrew W D'Souza
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, ON, Canada
| | - David B Nelson
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Safia Khan
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrew R Tomlinson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA.
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.
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10
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Washio T, Ogoh S. Point/counterpoint: Arterial blood pressure response to exercise does relate to exercise-induced improvement in cognitive function. J Cereb Blood Flow Metab 2023; 43:610-612. [PMID: 36704820 PMCID: PMC10063828 DOI: 10.1177/0271678x231153734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/28/2023]
Abstract
Exercise is a beneficial intervention to prevent cognitive dysfunction. However, an optimal exercise prescription for preventing dementia has not been established because the physiological mechanism(s) of exercise-induced improvements in cognitive function remains unclear. Interestingly, our recent study demonstrated that individuals with a higher exercise pressor response exhibit less exercise-induced cognitive improvement, suggesting that individual differences in cardiovascular responses to exercise or its associated physiological factors, may be related to exercise-induced alterations in cognitive function. Therefore, consideration of individual cardiovascular responses is warranted to develop appropriate exercise prescriptions for a given individual to prevent cognitive dysfunction.
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Affiliation(s)
- Takuro Washio
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe, Saitama, Japan
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11
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Washio T, Krainski F, Fu Q, Levine BD. Blood pressure during ambulation: are noninvasive beat-by-beat finger measures and intermittent brachial measures comparable? Clin Auton Res 2023; 33:197-199. [PMID: 36800050 DOI: 10.1007/s10286-023-00930-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Affiliation(s)
- Takuro Washio
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Ste. 435, Dallas, TX, USA.,The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Felix Krainski
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Ste. 435, Dallas, TX, USA.,The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Ste. 435, Dallas, TX, USA.,The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Ste. 435, Dallas, TX, USA. .,The University of Texas Southwestern Medical Center, Dallas, TX, USA.
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12
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D'Souza AW, Hissen SL, Okada Y, Jarvis SS, Washio T, Akins JD, Nelson DB, Fu Q. Differential regulation of sympathetic neural burst frequency and amplitude throughout normal pregnancy: a longitudinal study. Am J Physiol Regul Integr Comp Physiol 2023; 324:R249-R259. [PMID: 36534586 PMCID: PMC9902229 DOI: 10.1152/ajpregu.00239.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Sympathetic activation is a hallmark of pregnancy. However, longitudinal assessments of muscle sympathetic nerve activity (MSNA) in pregnancy are scarce and have primarily focused on burst occurrence (frequency) at rest, despite burst strength (amplitude) representing distinct characteristics of sympathetic outflow. Thus, we assessed MSNA burst amplitude distributions in healthy women to determine the impact of normal pregnancy on neural discharge patterns in response to orthostatic stress. Twenty-six women were studied longitudinally during pre-, early- (4-8 wk of gestation), and late (32-36 wk) pregnancy, as well as postpartum (6-10 wk after delivery). MSNA, blood pressure (BP), and heart rate (HR) were measured in the supine posture and during graded head-up tilt (30° and 60° HUT). Mean and median MSNA burst amplitudes were used to characterize burst amplitude distribution. In late pregnancy, women demonstrated smaller increases in HR (P < 0.001) during 60° HUT and larger increases in systolic BP (P = 0.043) throughout orthostasis, compared with prepregnancy. The increase in MSNA burst frequency during late- relative to prepregnancy (Late: Δ14[10] vs. Pre: Δ21[9] bursts/min; P = 0.001) was smaller during 60° HUT, whereas increases in burst incidence were smaller in late- relative to prepregnancy throughout orthostasis (P = 0.009). Nonetheless, median burst amplitude was smaller throughout orthostasis in late compared with prepregnancy (P = 0.038). Thus, while supine MSNA burst frequency was greater in late pregnancy, increases in burst frequency and strength during orthostasis were attenuated. These smaller, orthostatically induced MSNA increases may reflect natural adaptions of pregnancy serving to prevent sympathetic hyper-reactivity that is common in pathological states.
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Affiliation(s)
- Andrew W D'Souza
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sarah L Hissen
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yoshiyuki Okada
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Special Care Dentistry, Hiroshima University, Hiroshima, Japan
| | - Sara S Jarvis
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona
| | - Takuro Washio
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - John D Akins
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - David B Nelson
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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13
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Manabe K, D’Souza AW, Washio T, Takeda R, Hissen SL, Akins JD, Fu Q. Sympathetic and hemodynamic responses to exercise in heart failure with preserved ejection fraction. Front Cardiovasc Med 2023; 10:1148324. [PMID: 37139124 PMCID: PMC10150451 DOI: 10.3389/fcvm.2023.1148324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Excessive sympathetic activity during exercise causes heightened peripheral vasoconstriction, which can reduce oxygen delivery to active muscles, resulting in exercise intolerance. Although both patients suffering from heart failure with preserved and reduced ejection fraction (HFpEF and HFrEF, respectively) exhibit reduced exercise capacity, accumulating evidence suggests that the underlying pathophysiology may be different between these two conditions. Unlike HFrEF, which is characterized by cardiac dysfunction with lower peak oxygen uptake, exercise intolerance in HFpEF appears to be predominantly attributed to peripheral limitations involving inadequate vasoconstriction rather than cardiac limitations. However, the relationship between systemic hemodynamics and the sympathetic neural response during exercise in HFpEF is less clear. This mini review summarizes the current knowledge on the sympathetic (i.e., muscle sympathetic nerve activity, plasma norepinephrine concentration) and hemodynamic (i.e., blood pressure, limb blood flow) responses to dynamic and static exercise in HFpEF compared to HFrEF, as well as non-HF controls. We also discuss the potential of a relationship between sympathetic over-activation and vasoconstriction leading to exercise intolerance in HFpEF. The limited body of literature indicates that higher peripheral vascular resistance, perhaps secondary to excessive sympathetically mediated vasoconstrictor discharge compared to non-HF and HFrEF, drives exercise in HFpEF. Excessive vasoconstriction also may primarily account for over elevations in blood pressure and concomitant limitations in skeletal muscle blood flow during dynamic exercise, resulting in exercise intolerance. Conversely, during static exercise, HFpEF exhibit relatively normal sympathetic neural reactivity compared to non-HF, suggesting that other mechanisms beyond sympathetic vasoconstriction dictate exercise intolerance in HFpEF.
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Affiliation(s)
- Kazumasa Manabe
- Women’s Heart Health Laboratory, Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital, Dallas, TX, United States
- Cardiology Division, Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Andrew W. D’Souza
- Women’s Heart Health Laboratory, Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital, Dallas, TX, United States
- Cardiology Division, Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, United States
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, ON, Canada
| | - Takuro Washio
- Women’s Heart Health Laboratory, Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital, Dallas, TX, United States
- Cardiology Division, Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Ryosuke Takeda
- Women’s Heart Health Laboratory, Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital, Dallas, TX, United States
- Cardiology Division, Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sarah L. Hissen
- Women’s Heart Health Laboratory, Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital, Dallas, TX, United States
- Cardiology Division, Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - John D. Akins
- Women’s Heart Health Laboratory, Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital, Dallas, TX, United States
- Cardiology Division, Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Qi Fu
- Women’s Heart Health Laboratory, Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital, Dallas, TX, United States
- Cardiology Division, Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, United States
- Correspondence: Qi Fu
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14
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D’Souza AW, Yoo JK, Takeda R, Badrov MB, Anderson EH, Washio T, North CS, Suris A, Nelson MD, Shoemaker JK, Fu Q. Neurocardiovascular Dysregulation During Orthostasis in Women With Posttraumatic Stress Disorder. Circulation 2022; 146:1483-1485. [PMID: 36343104 PMCID: PMC9673184 DOI: 10.1161/circulationaha.122.061705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Andrew W. D’Souza
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeung-Ki Yoo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ryosuke Takeda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mark B. Badrov
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
- University Health Network and Sinai Health Division of Cardiology, Department of Medicine, University of Toronto and the Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Elizabeth H. Anderson
- Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
- Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Takuro Washio
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carol S. North
- Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
- Metrocare Services, Dallas, Texas
| | - Alina Suris
- Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
- Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Michael D. Nelson
- Department of Kinesiology, The University of Texas at Arlington, Arlington, Texas
| | - J. Kevin Shoemaker
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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15
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Watanabe H, Washio T, Saito S, Hirasawa A, Suzuki R, Shibata S, Brothers RM, Ogoh S. Validity Of Transcranial Doppler Ultrasonography-determined Dynamic Cerebral Autoregulation Estimated Using Transfer Function Analysis. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000882064.73853.dd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Saito S, Watanabe H, Washio T, Katayama K, Ogoh S. Influence Of Cardiac Output Response To The Onset Of Exercise On Cerebral Blood Flow. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000877600.28962.0f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Ogoh S, Washio T, Stacey BS, Tsukamoto H, Iannetelli A, Owens TS, Calverley TA, Fall L, Marley CJ, Bailey DM. Effects of continuous hypoxia on flow-mediated dilation in the cerebral and systemic circulation: on the regulatory significance of shear rate phenotype. J Physiol Sci 2022; 72:16. [PMID: 35858836 DOI: 10.1186/s12576-022-00841-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/07/2022] [Indexed: 11/10/2022]
Abstract
Emergent evidence suggests that cyclic intermittent hypoxia increases cerebral arterial shear rate and endothelial function, whereas continuous exposure decreases anterior cerebral oxygen (O2) delivery. To examine to what extent continuous hypoxia impacts cerebral shear rate, cerebral endothelial function, and consequent cerebral O2 delivery (CDO2), eight healthy males were randomly assigned single-blind to 7 h passive exposure to both normoxia (21% O2) and hypoxia (12% O2). Blood flow in the brachial and internal carotid arteries were determined using Duplex ultrasound and included the combined assessment of systemic and cerebral endothelium-dependent flow-mediated dilatation. Systemic (brachial artery) flow-mediated dilatation was consistently lower during hypoxia (P = 0.013 vs. normoxia), whereas cerebral flow-mediated dilation remained preserved (P = 0.927 vs. normoxia) despite a reduction in internal carotid artery antegrade shear rate (P = 0.002 vs. normoxia) and CDO2 (P < 0.001 vs. normoxia). Collectively, these findings indicate that the reduction in CDO2 appears to be independent of cerebral endothelial function and contrasts with that observed during cyclic intermittent hypoxia, highlighting the regulatory importance of (hypoxia) dose duration and flow/shear rate phenotype.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe, Saitama, Japan.,Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe, Saitama, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Benjamin S Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK
| | - Hayato Tsukamoto
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK.,Faculty of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Angelo Iannetelli
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK
| | - Thomas S Owens
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK
| | - Thomas A Calverley
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK
| | - Lewis Fall
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK
| | - Christopher J Marley
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK. .,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.
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18
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Saito S, Washio T, Watanabe H, Katayama K, Ogoh S. Influence of cardiac output response to the onset of exercise on cerebral blood flow. Eur J Appl Physiol 2022; 122:1939-1948. [PMID: 35660969 DOI: 10.1007/s00421-022-04973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Change in cardiac output (Q) contributes to cerebral blood flow (CBF) regulation at rest and even during steady-state exercise. At the onset of cycling exercise, Q increases acutely and largely via muscle pump. The purpose of the present study was to examine whether onset exercise-induced a large increase in Q contributes to CBF regulation at the onset of exercise. METHODS In 20 young healthy participants (10 males and 10 females), Q, mean arterial pressure (MAP), and mean blood velocities of middle and posterior cerebral arteries (MCA Vm and PCA Vm) were continuously measured during light cycling exercise for 3 min. RESULTS At the onset of exercise, Q increased acutely to the peak (P < 0.001), while the CBF peak responses were not significantly higher than the values during the steady-state exercise (MCA Vm and PCA Vm; P = 0.183 and P = 0.101, respectively). The change in Q was correlated with that of MCA Vm or PCA Vm from resting baseline to the steady-state exercise (r = 0.404, P < 0.001 and r = 0.393, P < 0.001, respectively). However, the change in Q was not correlated with that of MCA Vm or PCA Vm at the onset of exercise (P = 0.853 and P = 0.893, respectively). Any sex differences in the onset response of peripheral and cerebral hemodynamics to exercise were not observed. CONCLUSION These findings suggest that the acute change in Q does not contribute to CBF regulation at the onset of exercise for protecting cerebral vasculature against a large and acute elevation in Q at the onset of exercise.
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Affiliation(s)
- Shotaro Saito
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan
| | - Hironori Watanabe
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan
| | - Keisho Katayama
- Research Center of Health, Physical Fitness, and Sports, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan. .,Neurovascular Research Laboratory, University of South Wales, Pontypridd, UK.
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19
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Washio T, Yoo J, Anderson EH, Takeda R, Hissen SL, Nelson MD, North CS, Suris A, Fu Q. Cardiovascular and Sympathetic Neural Responses to Cognitive Tasks in Women with Posttraumatic Stress Disorder. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r4051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Takuro Washio
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian HospitalDallasTX
| | - Jeung‐Ki Yoo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian HospitalDallasTX
| | | | - Ryosuke Takeda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian HospitalDallasTX
| | - Sarah L. Hissen
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian HospitalDallasTX
| | | | | | - Alina Suris
- University of Texas Southwestern Medical CenterDallasTX
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian HospitalDallasTX
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20
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Washio T, Watanabe H, Suzuki K, Saito S, Ogoh S. Site-specific different dynamic cerebral autoregulation and cerebrovascular response to carbon dioxide in posterior cerebral circulation during isometric exercise in healthy young men. Auton Neurosci 2022; 238:102943. [PMID: 35086019 DOI: 10.1016/j.autneu.2022.102943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/16/2021] [Accepted: 01/16/2022] [Indexed: 11/23/2022]
Abstract
Different cerebral blood flow (CBF) responses to exercise between the posterior cerebral artery (PCA) and vertebral artery (VA) have been previously observed, though the physiological mechanisms remain unknown. There is regional heterogeneity in sympathetic innervation between the PCA and VA, which may affect CBF regulation, especially during sympathoexcitation. Thus, in the present study, we hypothesized that different CBF regulatory mechanisms between PCA and VA contribute to heterogeneous CBF responses to isometric exercise. To test this hypothesis, in thirteen healthy young men, dynamic cerebral autoregulation (CA) and cerebrovascular CO2 reactivity (CVR), were identified in each artery during a 2-min isometric handgrip (IHG) exercise at 30% of maximum voluntary contraction. Similar to previous data, PCA cerebrovascular conductance (CVC) index was decreased from rest (P < 0.004), but not VA CVC during IHG exercise (P > 0.084). Dynamic CA in both PCA and VA were unaltered during the IHG exercise (P = 0.129). On the other hand, PCA CVR was increased during the IHG exercise (P < 0.001) while VA CVR was unchanged (P = 0.294). In addition, individual exercise-induced changes in end-tidal partial pressure of CO2 was related to the individual change in PCA blood velocity (P < 0.046), but was not observed for VA blood flow (P > 0.420). Therefore, these exercise-induced differences in CVR between PCA and VA may contribute to exercise-induced heterogeneous CBF response in the posterior cerebral circulation. These findings indicate that the site-specific posterior CBF should be considered in further research for assessing posterior cerebral circulation.
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Affiliation(s)
- Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Hironori Watanabe
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Kazuya Suzuki
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Shotaro Saito
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan; Neurovascular Research Laboratory, University of South Wales, UK.
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Watanabe H, Saito S, Washio T, Bailey DM, Ogoh S. Acute Gravitational Stress Selectively Impairs Dynamic Cerebrovascular Reactivity in the Anterior Circulation Independent of Changes to the Central Respiratory Chemoreflex. Front Physiol 2022; 12:749255. [PMID: 35069233 PMCID: PMC8770752 DOI: 10.3389/fphys.2021.749255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Cerebrovascular reactivity (CVR) to changes in the partial pressure of arterial carbon dioxide (PaCO2) is an important mechanism that maintains CO2 or pH homeostasis in the brain. To what extent this is influenced by gravitational stress and corresponding implications for the regulation of cerebral blood flow (CBF) remain unclear. The present study examined the onset responses of pulmonary ventilation (V̇E) and anterior middle (MCA) and posterior (PCA) cerebral artery mean blood velocity (Vmean) responses to acute hypercapnia (5% CO2) to infer dynamic changes in the central respiratory chemoreflex and cerebrovascular reactivity (CVR), in supine and 50° head-up tilt (HUT) positions. Each onset response was evaluated using a single-exponential regression model consisting of the response time latency [CO2-response delay (t0)] and time constant (τ). Onset response of V̇E and PCA Vmean to changes in CO2 was unchanged during 50° HUT compared with supine (τ: V̇E, p = 0.707; PCA Vmean, p = 0.071 vs. supine) but the MCA Vmean onset response was faster during supine than during 50° HUT (τ: p = 0.003 vs. supine). These data indicate that gravitational stress selectively impaired dynamic CVR in the anterior cerebral circulation, whereas the posterior circulation was preserved, independent of any changes to the central respiratory chemoreflex. Collectively, our findings highlight the regional heterogeneity underlying CBF regulation that may have translational implications for the microgravity (and hypercapnia) associated with deep-space flight notwithstanding terrestrial orthostatic diseases that have been linked to accelerated cognitive decline and neurodegeneration.
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Affiliation(s)
- Hironori Watanabe
- Department of Biomedical Engineering, Toyo University, Kawagoe, Japan
| | - Shotaro Saito
- Department of Biomedical Engineering, Toyo University, Kawagoe, Japan
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Damian Miles Bailey
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.,Neurovascular Research Laboratory, University of South Wales, Pontypridd, United Kingdom
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe, Japan.,Neurovascular Research Laboratory, University of South Wales, Pontypridd, United Kingdom
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22
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Watanabe H, Washio T, Saito S, Ogoh S. Effect of breath-hold on the responses of arterial blood pressure and cerebral blood velocity to isometric exercise. Eur J Appl Physiol 2021; 122:157-168. [PMID: 34618221 DOI: 10.1007/s00421-021-04822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/25/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The present study examined the effect of breath-hold without a Valsalva maneuver during isometric exercise on arterial blood pressure (ABP) and cerebral blood flow (CBF). METHODS Twenty healthy adults (15 men and five women) randomly performed only breath-hold without a Valsalva maneuver (BH), and an isometric handgrip exercise for 30 s at 40% of individual maximal voluntary contraction with continuous breathing (IHG) and with breath-hold without the Valsalva maneuver (IHG-BH). Mean ABP (MAP) and blood velocity in the middle (MCA Vmean) and posterior cerebral arteries (PCA Vmean) were continuously measured throughout each protocol. RESULTS MAP was elevated during the IHG-BH compared with IHG (P < 0.001) and BH (P = 0.001). Similarly, both MCA Vmean and PCA Vmean were higher during IHG-BH compared with IHG and BH (all P < 0.001). Moreover, the relative change in MAP from the baseline was correlated with that in both cerebral blood velocities during the BH (MCA Vmean: r = 0.739, P < 0.001 and PCA Vmean: r = 0.570, P = 0.009) and IHG-BH (MCA Vmean: r = 0.755, P < 0.001 and PCA Vmean: r = 0.617, P = 0.003) condition, but not the IHG condition (P = 0.154 and P = 0.306). CONCLUSION These results indicate that during isometric exercise, a breath-hold enhances an exercise-induced increase in MAP and, consequently, MCA Vmean and PCA Vmean.
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Affiliation(s)
- Hironori Watanabe
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Shotaro Saito
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan. .,Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.
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23
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Ogoh S, Washio T, Stacey BS, Tsukamoto H, Iannetelli A, Owens TS, Calverley TA, Fall L, Marley CJ, Saito S, Watanabe H, Hashimoto T, Ando S, Miyamoto T, Bailey DM. Integrated respiratory chemoreflex-mediated regulation of cerebral blood flow in hypoxia: Implications for oxygen delivery and acute mountain sickness. Exp Physiol 2021; 106:1922-1938. [PMID: 34318560 DOI: 10.1113/ep089660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/20/2021] [Indexed: 12/30/2022]
Abstract
NEW FINDINGS What is the central question of this study? To what extent do hypoxia-induced changes in the peripheral and central respiratory chemoreflex modulate anterior and posterior cerebral oxygen delivery, with corresponding implications for susceptibility to acute mountain sickness? What is the main finding and its importance? We provide evidence for site-specific regulation of cerebral blood flow in hypoxia that preserves oxygen delivery in the posterior but not the anterior cerebral circulation, with minimal contribution from the central respiratory chemoreflex. External carotid artery vasodilatation might prove to be an alternative haemodynamic risk factor that predisposes to acute mountain sickness. ABSTRACT The aim of the present study was to determine the extent to which hypoxia-induced changes in the peripheral and central respiratory chemoreflex modulate anterior and posterior cerebral blood flow (CBF) and oxygen delivery (CDO2 ), with corresponding implications for the pathophysiology of the neurological syndrome, acute mountain sickness (AMS). Eight healthy men were randomly assigned single blind to 7 h of passive exposure to both normoxia (21% O2 ) and hypoxia (12% O2 ). The peripheral and central respiratory chemoreflex, internal carotid artery, external carotid artery (ECA) and vertebral artery blood flow (duplex ultrasound) and AMS scores (questionnaires) were measured throughout. A reduction in internal carotid artery CDO2 was observed during hypoxia despite a compensatory elevation in perfusion. In contrast, vertebral artery and ECA CDO2 were preserved, and the former was attributable to a more marked increase in perfusion. Hypoxia was associated with progressive activation of the peripheral respiratory chemoreflex (P < 0.001), whereas the central respiratory chemoreflex remained unchanged (P > 0.05). Symptom severity in participants who developed clinical AMS was positively related to ECA blood flow (Lake Louise score, r = 0.546-0.709, P = 0.004-0.043; Environmental Symptoms Questionnaires-Cerebral symptoms score, r = 0.587-0.771, P = 0.001-0.027, n = 4). Collectively, these findings highlight the site-specific regulation of CBF in hypoxia that maintains CDO2 selectively in the posterior but not the anterior cerebral circulation, with minimal contribution from the central respiratory chemoreflex. Furthermore, ECA vasodilatation might represent a hitherto unexplored haemodynamic risk factor implicated in the pathophysiology of AMS.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe, Saitama, Japan.,Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe, Saitama, Japan
| | - Benjamin S Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Hayato Tsukamoto
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.,Faculty of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Angelo Iannetelli
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Thomas S Owens
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Thomas A Calverley
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Lewis Fall
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Christopher J Marley
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Shotaro Saito
- Department of Biomedical Engineering, Toyo University, Kawagoe, Saitama, Japan
| | - Hironori Watanabe
- Department of Biomedical Engineering, Toyo University, Kawagoe, Saitama, Japan
| | - Takeshi Hashimoto
- Faculty of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Soichi Ando
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
| | | | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
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24
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Saito S, Washio T, Watanabe H, Ando S, Ogoh S. Effect of intermittent isometric handgrip exercise protocol with short exercise duration on cognitive performance. J Physiol Sci 2021; 71:12. [PMID: 33823784 PMCID: PMC10717478 DOI: 10.1186/s12576-021-00796-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/17/2021] [Indexed: 11/10/2022]
Abstract
The handgrip exercise, a small muscle exercise, is useful for exercise therapy, particularly in the elderly and bedridden patients. The isometric handgrip (IHG) exercise has been utilized in training programs to reduce resting blood pressure; however, the acute effects of the IHG exercise on cognitive performance are not fully understood. The present study aimed to investigate the effect of an intermittent IHG exercise protocol with short exercise duration, which minimizes the arterial blood pressure response to exercise, on cognitive performance. Twenty-two young healthy subjects performed the intermittent IHG exercise protocol, which consisted of 30-s IHG and 45-s recovery × 16 trials; the exercise intensity of the IHG exercise was 30% of the maximal voluntary contraction. Cognitive performance was evaluated before and after the exercise with the Go/No-Go and memory recognition tasks. Specifically, the reaction time (RT) and performance accuracy were measured. The intermittent IHG exercise protocol did not change the RT or performance accuracy of either the Go/No-Go task (P = 0.222 and P = 0.260, respectively) or the memory recognition task (P = 0.427 and P = 0.245, respectively). These findings suggest that the intermittent IHG exercise protocol with short exercise duration may not provide enough stimulation to improve cognitive performance despite being useful as a safe exercise therapy in the elderly and in patients with cardiovascular disease.
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Affiliation(s)
- Shotaro Saito
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Hironori Watanabe
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan
| | - Soichi Ando
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan.
- Neurovascular Research Laboratory, University of South Wales, Pontypridd, UK.
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25
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Washio T, Suzuki K, Saito S, Watanabe H, Ando S, Brothers RM, Ogoh S. Effects of acute interval handgrip exercise on cognitive performance. Physiol Behav 2021; 232:113327. [PMID: 33493545 DOI: 10.1016/j.physbeh.2021.113327] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
Previous studies have reported that even a single bout of dynamic exercise improves cognitive performance. However, the acute effect of the interval handgrip (HG) exercise protocol, which is effective in reducing resting blood pressure, on cognitive performance is poorly understood. Cognitive performance was assessed in 17 young healthy subjects before and after a resting control (e.g., time control) and the interval HG exercise (Exercise), which consisted of four trials of 2-min HG exercise at 25% of maximum voluntary contraction with 3-min recovery in between each trial. Mean arterial blood pressure (MAP) and middle cerebral artery blood velocity (MCA V) were measured continuously throughout the experiment. Memory recognition and executive function were assessed using memory recognition and Go/No-Go tasks, respectively. During interval HG exercise, MAP and mean MCA V increased from the resting baseline condition (both P < 0.049) and returned to the resting baseline levels during recovery after the interval HG exercise (both P = 1.000). The reaction time and performance accuracy of the memory recognition task did not change in either the time control condition or Exercise condition (P = 0.514 and P = 0.414 respectively). However, the changes in reaction time of Go/No-Go task from the baseline in Exercise condition was significantly shorter than that in time-control condition (P = 0.004) without affecting performance accuracy (P = 0.482). The results of the present study show that an acute interval HG exercise could improve the processing speed in executive function despite no post-exercise improvement in hemodynamic parameters in young healthy subjects. These findings suggest that the interval HG exercise is a useful exercise mode that can be expected to have a positive effect on the processing speed in executive function regardless of cardiovascular adaptation to exercise.
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Affiliation(s)
- Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan; Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kazuya Suzuki
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Shotaro Saito
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Hironori Watanabe
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Soichi Ando
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
| | - R Matthew Brothers
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan.
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26
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Suzuki K, Washio T, Tsukamoto S, Kato K, Iwamoto E, Ogoh S. Habitual cigarette smoking attenuates shear-mediated dilation in the brachial artery but not in the carotid artery in young adults. Physiol Rep 2021; 8:e14369. [PMID: 32061192 PMCID: PMC7023886 DOI: 10.14814/phy2.14369] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/16/2020] [Accepted: 01/19/2020] [Indexed: 12/22/2022] Open
Abstract
In the present study, we hypothesized that habitual cigarette smoking attenuates endothelial function in the cerebral circulation as well as that of the peripheral circulation in young adults. To test this hypothesis, we measured cerebrovascular and peripheral flow‐mediated dilation (FMD) in young smokers and nonsmokers in the present study. Ten healthy nonsmokers and 10 smokers participated in the study. We measured blood velocity and diameter in the brachial artery and internal carotid artery (ICA) using Doppler ultrasound. We identified shear‐mediated dilation in the brachial artery and ICA by the percentage change in peak diameter during hyperemia stimulation (reactive hyperemia and hypercapnia). We measured the baseline diameter and the shear rate area under the curve from the onset of hyperemia to peak dilation in the brachial artery and ICA, finding the measurements of the smokers and those of the nonsmokers did not differ (p > .05). In contrast to brachial FMD (5.07 ± 1.79% vs. 7.92 ± 3.01%; smokers vs. nonsmokers, p = .019), FMD in the ICA was not attenuated in the smokers compared with that of the nonsmokers (5.46 ± 2.32% vs. 4.57 ± 2.70%; p = .442). These findings indicate that in young healthy smokers, cerebral endothelial function was preserved, and the response of cerebral endothelial function to smoking was different from that of peripheral vasculature.
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Affiliation(s)
- Kazuya Suzuki
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Shingo Tsukamoto
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Kazunori Kato
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Erika Iwamoto
- School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
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27
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Ogoh S, Washio T, Suzuki K, Iemitsu M, Hashimoto T, Iwamoto E, Bailey DM. Greater increase in internal carotid artery shear rate during aerobic interval compared to continuous exercise in healthy adult men. Physiol Rep 2021; 9:e14705. [PMID: 33463912 PMCID: PMC7814484 DOI: 10.14814/phy2.14705] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 12/26/2022] Open
Abstract
Interval exercise has been determined to be more effective than continuous exercise for achieving improvement in the cardiovascular function of individuals suffering from cardiovascular disease. However, whether interval exercise improves the cerebrovascular function remains unclear. As per our hypothesis, interval exercise induces a higher cerebrovascular shear rate (SR) than continuous exercise. In this study, 11 adult men randomly performed continuous exercise for 12 min or work-equivalent (57.6 kJ/exercise session) interval exercise of semi-recumbent cycling. The SR in the internal carotid artery (ICA) represents an index of the cerebrovascular SR, which was measured during both the exercises using Doppler ultrasonography. Both the aerobic exercise modes increased the ICA SR. Moreover, the average ICA SR of the interval exercise for the final 4 min of exercise or 2 min of recovery was significantly higher than that for continuous exercise (exercise, 351 ± 75 vs. 330 ± 61/s, p = .038; recovery, 327 ± 86 vs. 290 ± 56/s, p = .014). To our knowledge, this is the first study to show that aerobic interval exercise increased the ICA SR more than equivalent work volume of aerobic continuous exercise. Thus, aerobic interval exercise may be more effective at stimulating the cerebrovasculature, resulting in greater improvements in cerebrovascular function as compared to continuous aerobic exercise in healthy adult men. These findings provide some important information that would help enhance exercise therapy programs for patients with arteriosclerosis, especially in the cerebral circulation.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical EngineeringToyo UniversityKawagoe‐ShiJapan
- Neurovascular Research LaboratoryUniversity of South WalesPontypriddUK
| | - Takuro Washio
- Department of Biomedical EngineeringToyo UniversityKawagoe‐ShiJapan
- Research Fellow of Japan Society for the Promotion of ScienceTokyoJapan
| | - Kazuya Suzuki
- Department of Biomedical EngineeringToyo UniversityKawagoe‐ShiJapan
| | - Motoyuki Iemitsu
- Faculty of Sport and Health ScienceRitsumeikan UniversityShigaJapan
| | | | - Erika Iwamoto
- School of Health SciencesSapporo Medical UniversitySapporoJapan
| | - Damian M. Bailey
- Neurovascular Research LaboratoryUniversity of South WalesPontypriddUK
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28
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Ogoh S, Washio T, Paton JFR, Fisher JP, Petersen LG. Gravitational effects on intracranial pressure and blood flow regulation in young men: a potential shunting role for the external carotid artery. J Appl Physiol (1985) 2020; 129:901-908. [PMID: 32816640 DOI: 10.1152/japplphysiol.00369.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We sought to determine whether gravity-induced changes in intracranial pressure influence cerebral blood flow regulation. Accordingly, nine young healthy men were studied while supine (0°) and during mild changes in hydrostatic pressure induced by head-up tilt at +20° and +10° (HUT+20 and HUT+10) and head-down tilt at -20° and -10° (HDT-20, HDT-10). Blood flows were measured in the internal and external carotid and vertebral arteries (ICA, ECA, and VA). Intraocular pressure (IOP) was measured as an indicator of hydrostatic changes in intracranial pressure. A posture change from HUT+20 to HDT-20 increased IOP by +5.1 ± 1.9 mmHg (P < 0.001) and ECA blood flow (from 61.7 ± 26.1 to 87.6 ± 46.4 mL/min, P = 0.004) but did not affect ICA (P = 0.528) or VA (P = 0.101) blood flow. The increase in ECA flow correlated with the tilt angle and resultant changes in intracranial pressures (by IOP), thus indicating a passive hydrostatic gravitational dependence (r = 0.371, P = 0.012). On the contrary, ICA flow remained constant and thus well protected against moderate orthostatic stress. When ICA flow was corrected for the gravitational changes in intracranial pressures (by IOP), it demonstrated the same magnitude of gravitational dependence as ECA. These findings suggest that passive hydrostatic increases in intracranial pressure outbalance the concurrent increase in arterial feeding pressure to the brain and thus prevent cerebral hyperperfusion during HDT. The mechanism for maintaining constant cerebral flow was by increased ECA flow, thus supporting the role of these vascular beds as a shunting pathway.NEW & NOTEWORTHY We investigated whether gravity-induced changes in intracranial pressure influence cerebral blood flow regulation in young men. We recorded extra- and intracerebral blood flow during changes in posture, and data indicate that the external carotid artery may serve as an overflow pathway to prevent cerebral hyperperfusion during increases in cerebral arterial blood pressure.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Julian F R Paton
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - James P Fisher
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lonnie G Petersen
- Department of Biomedical Science, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.,Department of Radiology, University of California, San Diego, California.,Department of Mechanical and Aerospace Engineering, University of California, San Diego, California
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Watanabe H, Washio T, Kimura K, Ogoh S. Effect Of Breath Holding On Cerebral Blood Flow Response To Isometric Exercise. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000678076.05014.f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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30
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Ogoh S, Washio T, Suzuki K, Iemitsu M, Hashimoto T, Iwamoto E, Bailey D. Effect Of Different Exercise Modes On Cerebrovascular Shear In Humans. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000678068.82443.a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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31
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Tamiya K, Washio T, Miyamoto T, Bailey D, Ogoh S. Interpretive Complications Underlying Cerebrovascular Response To Hypercapnia; Significance Of The Central Respiratory Chemoreflex Transient. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000678024.33742.b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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32
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Saito S, Tamiya K, Washio T, Watanabe H, Ando S, Ogoh S. Effect Of Intermittent Isometric Handgrip Exercise On Cognitive Function. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000680920.04598.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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33
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Bailey DM, Lanelle D, Trihan JE, Marchi N, Stacey B, Tamiya K, Washio T, Taillon E, Hirtz C, Lehmann S, Ogoh S, Normand H. gravitational Transitions Increase Blood-brain Barrier Permeability In Humans. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000683720.62895.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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34
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Washio T, Watanabe H, Suzuki K, Tamiya K, Saito S, Ogoh S. Handgrip Exercise Modulates Cerebrovascular Response To Hypercapnia In The Anterior And Posterior Circulation. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000678040.25831.d1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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35
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Bailey DM, Lanéelle D, Trihan JE, Marchi N, Stacey BS, Tamiya K, Washio T, Tuaillon E, Hirtz C, Lehmann S, Ogoh S, Normand H. Gravitational Transitions Increase Posterior Cerebral Perfusion and Systemic Oxidative-nitrosative Stress: Implications for Neurovascular Unit Integrity. Neuroscience 2020; 441:142-160. [PMID: 32502571 DOI: 10.1016/j.neuroscience.2020.05.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022]
Abstract
The present study examined if repeated bouts of micro- and hypergravity during parabolic flight (PF) alter structural integrity of the neurovascular unit (NVU) subsequent to free radical-mediated changes in regional cerebral perfusion. Six participants (5♂, 1♀) aged 29 ± 11 years were examined before, during and after a 3 h PF and compared to six sex and age-matched (27 ± 6 years) normogravity controls. Blood flow was measured in the anterior (middle cerebral artery, MCA; internal carotid artery, ICA) and posterior (vertebral artery, VA) circulation (duplex ultrasound) in-flight over the course of 15 parabolas. Venous blood was assayed for free radicals (electron paramagnetic resonance spectroscopy), nitric oxide (NO, ozone-based chemiluminescence) and NVU integrity (chemiluminescence/ELISA) in normogravity before and after exposure to 31 parabolas. While MCA velocity did not change (P > 0.05), a selective increase in VA flow was observed during the most marked gravitational transition from micro- to hypergravity (P < 0.05). Increased oxidative-nitrosative stress defined by a free radical-mediated reduction in NO and elevations in glio-vascular GFAP and S100ß were observed after PF (P < 0.05), the latter proportional to the increase in VA flow (r = 0.908, P < 0.05). In contrast, biomarkers of neuronal-axonal damage (neuron-specific enolase, neurofilament light-chain, ubiquitin carboxy-terminal hydrolase L1 and tau) did not change (P > 0.05). Collectively, these findings suggest that the cumulative effects of repeated gravitational transitions may promote minor blood-brain barrier disruption, potentially related to the combined effects of haemodynamic (posterior cerebral hyperperfusion) and molecular (systemic oxidative-nitrosative) stress.
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Affiliation(s)
- Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Glamorgan, UK.
| | - Damien Lanéelle
- Service de Médecine Vasculaire, Centre Hospitalo-Universitaire, Caen, France; UNICAEN, INSERM, COMETE, GIP CYCERON, Normandie University, Caen, France
| | - Jean-Eudes Trihan
- Service de Médecine Vasculaire, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Nicola Marchi
- UMR, Laboratory of Cerebrovascular and Glia Research, Department of Neuroscience, Institute of Functional Genomics (CNRS Unit Mixte de Recherche 5203; INSERM U1191), University of Montpellier, France
| | - Benjamin S Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Glamorgan, UK
| | - Kazuki Tamiya
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Edouard Tuaillon
- Unit Mixte de Recherche, INSERM l'Etablissement Français du Sang, University of Montpellier 1, Montpellier, France
| | - Christophe Hirtz
- LBPC-PPC, University of Montpellier, Institute of Regenerative Medicine-Biotherapy IRMB, Centre Hospitalier Universitaire de Montpellier, INSERM, Montpellier, France
| | - Sylvain Lehmann
- LBPC-PPC, University of Montpellier, Institute of Regenerative Medicine-Biotherapy IRMB, Centre Hospitalier Universitaire de Montpellier, INSERM, Montpellier, France
| | - Shigehiko Ogoh
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Glamorgan, UK; Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Hervé Normand
- UNICAEN, INSERM, COMETE, GIP CYCERON, Normandie University, Caen, France; UNICAEN, COMETE, Caen, France; INSERM, U 1075 COMETE, Caen, France; Department of Clinical Physiology, Centre Hospitalier Universitaire de Caen, Caen, France
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Washio T, Watanabe H, Ogoh S. Dynamic cerebral autoregulation in anterior and posterior cerebral circulation during cold pressor test. J Physiol Sci 2020; 70:1. [PMID: 32039699 PMCID: PMC6987085 DOI: 10.1186/s12576-020-00732-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/22/2020] [Indexed: 12/26/2022]
Abstract
We hypothesized that cerebral blood flow (CBF) regulation in the posterior circulation differs from that of the anterior circulation during a cold pressor test (CPT) and is accompanied by elevations in arterial blood pressure (ABP) and sympathetic nervous activity (SNA). To test this, dynamic cerebral autoregulation (dCA) in the middle and posterior cerebral arteries (MCA and PCA) were measured at three different conditions: control, early phase of the CPT, and the late phase of the CPT. The dCA was examined using a thigh cuff occlusion and release technique. The MCA and PCA blood velocities were unchanged at CPT compared with the control conditions despite an elevation in the ABP. The dCA in both the MCA and PCA remained unaltered at CPT. These findings suggest that CPT-induced elevations in the ABP and SNA did not cause changes in the CBF regulation in the posterior circulation compared with the anterior circulation.
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Affiliation(s)
- Takuro Washio
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Hironori Watanabe
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan.
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Ogoh S, Suzuki K, Washio T, Tamiya K, Saito S, Bailey TG, Shibata S, Ito G, Miyamoto T. Does respiratory drive modify the cerebral vascular response to changes in end-tidal carbon dioxide? Exp Physiol 2019; 104:1363-1370. [PMID: 31264258 DOI: 10.1113/ep087744] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/28/2019] [Indexed: 12/30/2022]
Abstract
NEW FINDINGS What is the central question of this study? There is an interaction between the regulatory systems of respiration and cerebral blood flow, because the mediator (CO2 ) is the same for both physiological systems. We examined whether the traditional method for determining cerebrovascular reactivity to CO2 is modified by changes in respiration. What is the main finding and its importance? Cerebrovascular reactivity was modified by voluntary changes in respiration during hypercapnia. This finding suggests that an alteration in the respiratory system may result in under- or overestimation of cerebrovascular reactivity determined by traditional methods in healthy adults. ABSTRACT The cerebral vasculature is sensitive to changes in the arterial partial pressure of CO2 . This physiological mechanism has been well established as a cerebrovascular reactivity to CO2 (CVR). However, arterial CO2 may not be an independent variable in the traditional method for assessment of CVR, because the cerebral blood flow response is also affected by the activation of respiratory drive or higher centres in the brain. We hypothesized that CVR is modified by changes in respiration. To test our hypothesis, in the present study, 10 young, healthy subjects performed hyper- or hypoventilation to change end-tidal CO2 ( P ET , C O 2 ) with different concentrations of CO2 in the inhaled gas (0, 2.0 and 3.5%). We measured middle cerebral artery mean blood flow velocity by transcranial Doppler ultrasonography to identify the cerebral blood flow response to change in P ET , C O 2 during each set of conditions. In each set of conditions, P ET , C O 2 was significantly altered by changes in ventilation, and middle cerebral artery mean blood flow velocity changed accordingly. However, the relationship between changes in middle cerebral artery mean blood flow velocity and P ET , C O 2 as a response curve of CVR was reset upwards and downwards by hypo- and hyperventilation, respectively, compared with CVR during normal ventilation. The findings of the present study suggest the possibility that an alteration in respiration might lead to under- or overestimation of CVR determined by the traditional methods.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Kazuya Suzuki
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kazuki Tamiya
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Shotaro Saito
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Tom G Bailey
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Shigeki Shibata
- Department of Physical Therapy, Faculty of Health Science, Kyorin University, Tokyo, Japan
| | - Go Ito
- Morinomiya University of Medical Sciences, Osaka, Japan
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Washio T, Suzuki K, Yamagata T, Ando S, Ogoh S. Effect Of Isometric Handgrip Exercise On Hypercapnia-induced Shear-mediated Dilation In The Internal Carotid Artery. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562510.52872.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bailey DM, Washio T, Suzuki K, Ogoh S. HIITing The Brain Enhances Cerebrovascular Shear Stress; The Link To Neuroprotection? Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562911.98173.0c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Suzuki K, Washio T, Tsukamoto S, Kato K, Iwamoto E, Ogoh S. Effect of cigarette smoking on hypercapnia induced shear‐mediated dilation in the internal carotid artery. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.688.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Washio T, Vranish JR, Kaur J, Young BE, Katayama K, Fadel PJ, Ogoh S. Acute reduction in posterior cerebral blood flow following isometric handgrip exercise is augmented by lower body negative pressure. Physiol Rep 2018; 6:e13886. [PMID: 30338667 PMCID: PMC6194212 DOI: 10.14814/phy2.13886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/16/2018] [Indexed: 01/31/2023] Open
Abstract
The mechanism(s) for the increased occurrence of a grayout or blackout, syncope, immediately after heavy resistance exercise are unclear. It is well-known that orthostatic stress increases the occurrence of postexercise syncope. In addition, previous findings have suggested that hypo-perfusion, especially in the posterior cerebral circulation rather than anterior cerebral circulation, may be associated with the occurrence of syncope. Herein, we hypothesized that the postexercise decrease in posterior, but not anterior, cerebral blood flow (CBF) would be greater during orthostatic stress. Nine healthy subjects performed 3-min isometric handgrip (HG) at 30% maximum voluntary contraction without (CONTROL) and during lower body negative pressure (LBNP; -40 Torr) while vertebral artery (VA) blood flow, as an index of posterior CBF, and middle cerebral artery blood velocity (MCAv), as an index of anterior CBF, were measured. Immediately after HG (0 to 15 sec of recovery phase), mean arterial pressure decreased but there was no difference in this reduction between CONTROL and LBNP conditions (-15.4 ± 4.0% and -17.0 ± 6.2%, P = 0.42). Similarly, MCAv decreased following exercise and was unaffected by the application of LBNP (P = 0.22). In contrast, decreases in VA blood flow immediately following HG during LBNP were significantly greater compared to CONTROL condition (-24.2 ± 9.5% and -13.4 ± 6.6%, P = 0.005). These findings suggest that the decrease in posterior CBF immediately following exercise was augmented by LBNP, whereas anterior CBF appeared unaffected. Thus, the posterior cerebral circulation may be more sensitive to orthostatic stress during the postexercise period.
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Affiliation(s)
- Takuro Washio
- Department of Biomedical EngineeringToyo UniversityKawagoe‐shiSaitamaJapan
- Research Fellow of Japan Society for the Promotion of ScienceTokyoJapan
| | | | - Jasdeep Kaur
- Department of KinesiologyUniversity of Texas at ArlingtonArlingtonTexas
| | - Benjamin E. Young
- Department of KinesiologyUniversity of Texas at ArlingtonArlingtonTexas
| | - Keisho Katayama
- Research Center of HealthPhysical Fitness and SportsNagoya UniversityNagoyaJapan
| | - Paul J. Fadel
- Department of KinesiologyUniversity of Texas at ArlingtonArlingtonTexas
| | - Shigehiko Ogoh
- Department of Biomedical EngineeringToyo UniversityKawagoe‐shiSaitamaJapan
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Kaur J, Vranish JR, Barbosa TC, Washio T, Young BE, Stephens BY, Brothers RM, Ogoh S, Fadel PJ. Regulation of Regional Cerebral Blood Flow During Graded Reflex-Mediated Sympathetic Activation via Lower Body Negative Pressure. J Appl Physiol (1985) 2018; 125:1779-1786. [PMID: 30188801 PMCID: PMC10392631 DOI: 10.1152/japplphysiol.00623.2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The role of the sympathetic nervous system in cerebral blood flow (CBF) regulation remains unclear. Previous studies have primarily measured middle cerebral artery blood velocity to assess CBF. Recently, there has been a transition towards measuring internal carotid artery (ICA) and vertebral artery (VA) blood flow using duplex Doppler ultrasound. Given that the VA supplies autonomic control centers in the brainstem, we hypothesized that graded sympathetic activation via lower body negative pressure (LBNP) would reduce ICA but not VA blood flow. ICA and VA blood flow were measured during two protocols: Protocol-1, low-to-moderate LBNP (-10, -20, -30, -40 Torr) and Protocol-2, moderate-to-high LBNP (-30, -50, -70 Torr). ICA and VA blood flow, diameter, and blood velocity were unaffected up to -40 LBNP. However, -50 and -70 LBNP evoked reductions in ICA and VA blood flow (e.g., -70 LBNP: %∆VA-baseline= -27.6±3.0) that were mediated by decreases in both diameter and velocity (e.g., -70 LBNP: %∆VA-baseline diameter= -7.5±1.9 and %∆VA-baseline velocity= -13.6±1.7), which were comparable between vessels. Since hyperventilation during -70 LBNP reduced PETCO2, this decrease in PETCO2 was matched via voluntary hyperventilation. Reductions in ICA and VA blood flow during hyperventilation alone were significantly smaller than during -70 LBNP and were primarily mediated by decreases in velocity (%∆VA-baseline velocity= -8.6±2.4; %∆VA-baseline diameter= -0.05±0.56). These data demonstrate that both ICA and VA were unaffected by low-to-moderate sympathetic activation, whereas robust reflex-mediated sympatho-excitation caused similar magnitudes of vasoconstriction in both arteries. Thus, contrary to our hypothesis, the ICA was not preferentially vasoconstricted by sympathetic activation.
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Affiliation(s)
- Jasdeep Kaur
- Department of Kinesiology, University of Texas at Arlington, United States
| | - Jennifer R Vranish
- Department of Kinesiology, University of Texas at Arlington, United States
| | - Thales C Barbosa
- Department of Kinesiology, University of Texas at Arlington, United States
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University
| | | | | | | | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Japan
| | - Paul J Fadel
- Department of Kinesiology, University of Texas at Arlington, United States
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Ogoh S, Washio T, Suzuki K, Ikeda K, Hori T, Olesen ND, Muraoka Y. Effect of leg immersion in mild warm carbonated water on skin and muscle blood flow. Physiol Rep 2018; 6:e13859. [PMID: 30221833 PMCID: PMC6139710 DOI: 10.14814/phy2.13859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/16/2018] [Indexed: 11/24/2022] Open
Abstract
Leg immersion in carbonated water improves endothelial-mediated vasodilator function and decreases arterial stiffness but the mechanism underlying this effect remains poorly defined. We hypothesized that carbonated water immersion increases muscle blood flow. To test this hypothesis, 10 men (age 21 ± 0 years; mean ± SD) underwent lower leg immersion in tap or carbonated water at 38°C. We evaluated gastrocnemius muscle oxyhemoglobin concentration and tissue oxygenation index using near-infrared spectroscopy, skin blood flow by laser Doppler flowmetry, and popliteal artery (PA) blood flow by duplex ultrasound. Immersion in carbonated, but not tap water elevated PA (from 38 ± 14 to 83 ± 31 mL/min; P < 0.001) and skin blood flow (by 779 ± 312%, P < 0.001). In contrast, lower leg immersion elevated oxyhemoglobin concentration and tissue oxygenation index with no effect of carbonation (P = 0.529 and P = 0.495). In addition, the change in PA blood flow in response to immersion in carbonated water correlated with those of skin blood flow (P = 0.005) but not oxyhemoglobin concentration (P = 0.765) and tissue oxygenation index (P = 0.136) while no relations was found for tap water immersion. These findings indicate that water carbonation has minimal effect on muscle blood flow. Furthermore, PA blood flow increases in response to lower leg immersion in carbonated water likely due to a large increase in skin blood flow.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical EngineeringToyo UniversityKawagoe‐ShiSaitamaJapan
| | - Takuro Washio
- Department of Biomedical EngineeringToyo UniversityKawagoe‐ShiSaitamaJapan
| | - Kazuya Suzuki
- Department of Biomedical EngineeringToyo UniversityKawagoe‐ShiSaitamaJapan
| | - Keisuke Ikeda
- Institute of Personal Health Care Products ResearchKao co ltd.TokyoJapan
| | - Takaaki Hori
- Institute of Personal Health Care Products ResearchKao co ltd.TokyoJapan
| | - Niels D. Olesen
- Department of AnesthesiaRigshospitaletCopenhagenDenmark
- Department of Biomedical SciencesUniversity of CopenhagenCopenhagenDenmark
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Watanabe Y, Takahashi H, Furuya S, Tani S, Washio T, Kawauchi K, Kobori M, Matsuzaki M, Yuzawa Y, Ashida T, Matsuo R, Yagyu S, Matsumoto N. P1550Gender difference in cholesterol levels associated with coronary microvascular dysfunction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Y Watanabe
- Nihon University Hospital, Department of Cardiology, Tokyo, Japan
| | - H Takahashi
- Nihon University Hospital, Department of Cardiology, Tokyo, Japan
| | - S Furuya
- Nihon University Hospital, Department of Cardiology, Tokyo, Japan
| | - S Tani
- Nihon University Hospital, Department of Cardiology, Tokyo, Japan
| | - T Washio
- Nihon University Hospital, Department of Cardiology, Tokyo, Japan
| | - K Kawauchi
- Nihon University Hospital, Department of Cardiology, Tokyo, Japan
| | - M Kobori
- Nihon University Hospital, Department of Cardiology, Tokyo, Japan
| | - M Matsuzaki
- Nihon University Hospital, Department of Cardiology, Tokyo, Japan
| | - Y Yuzawa
- Nihon University Hospital, Department of Cardiology, Tokyo, Japan
| | - T Ashida
- Nihon University Hospital, Department of Cardiology, Tokyo, Japan
| | - R Matsuo
- Nihon University Hospital, Department of Cardiology, Tokyo, Japan
| | - S Yagyu
- Nihon University Hospital, Department of Cardiology, Tokyo, Japan
| | - N Matsumoto
- Nihon University Hospital, Department of Cardiology, Tokyo, Japan
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Hatanaka M, Washio T, Sakurai H, Ogoh S. Effect of Acute Sleep Deprivation on Dynamic Cerebral Autoregulation. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536843.04140.9d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Suzuki K, Washio T, Hatanaka M, Sakurai H, Ogoh S. Ipsilateral and Contralateral Posterior Cerebral Artery Blood Velocities During Handgrip Exercise. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536838.25225.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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47
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Washio T, Hatanaka M, Suzuki K, Ogoh S. Effect of Sympathetic Activation on Dynamic Cerebral Autoregulation in Posterior Cerebral Circulation. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536844.11763.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Previous studies have suggested that the risk of ischemic stroke increases immediately after drinking coffee. Indeed, drinking coffee, that is, caffeine, acutely increases arterial stiffness as well as blood pressure and peripheral vascular resistance. On the other hand, it has been reported that arterial stiffening is associated with elevation in the pulsatility index (PI) of cerebral blood flow (CBF), which increases the risk of brain disease. However, the effect of drinking coffee on the PI of the CBF and its interaction with arterial stiffness remain unknown. Against this background, we hypothesized that an acute increase in arterial stiffness induced by drinking coffee augments cerebral pulsatile stress. To test this hypothesis, in 10 healthy young men we examined the effects of drinking coffee on the PI of middle cerebral artery blood velocity (MCAv) and brachial‐ankle pulse wave velocity (baPWV) as indices of cerebral pulsatile stress and arterial stiffness, respectively. Mean arterial blood pressure and baPWV were higher (P < 0.01 and P = 0.02), whereas mean MCAV and mean cerebrovascular conductance index were lower upon drinking coffee (P = 0.02 and P < 0.01) compared with a placebo (decaffeinated coffee). However, there was no difference in the PI of MCAv between drinking coffee and the placebo condition. These findings suggest that drinking coffee does not increase cerebral pulsatile stress acutely despite an elevation in arterial stiffness in the systemic circulation.
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Affiliation(s)
- Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe, Saitama, Japan
| | - Hiroyuki Sasaki
- Department of Biomedical Engineering, Toyo University, Kawagoe, Saitama, Japan
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe, Saitama, Japan
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Ogoh S, Moralez G, Washio T, Sarma S, Hieda M, Romero SA, Cramer MN, Shibasaki M, Crandall CG. Effect of increases in cardiac contractility on cerebral blood flow in humans. Am J Physiol Heart Circ Physiol 2017; 313:H1155-H1161. [PMID: 28916637 DOI: 10.1152/ajpheart.00287.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/05/2017] [Accepted: 09/12/2017] [Indexed: 01/17/2023]
Abstract
The effect of acute increases in cardiac contractility on cerebral blood flow (CBF) remains unknown. We hypothesized that the external carotid artery (ECA) downstream vasculature modifies the direct influence of acute increases in heart rate and cardiac function on CBF regulation. Twelve healthy subjects received two infusions of dobutamine [first a low dose (5 μg·kg-1·min-1) and then a high dose (15 μg·kg-1·min-1)] for 12 min each. Cardiac output, blood flow through the internal carotid artery (ICA) and ECA, and echocardiographic measurements were performed during dobutamine infusions. Despite increases in cardiac contractility, cardiac output, and arterial pressure with dobutamine, ICA blood flow and conductance slightly decreased from resting baseline during both low- and high-dose infusions. In contrast, ECA blood flow and conductance increased appreciably during both low- and high-dose infusions. Greater ECA vascular conductance and corresponding increases in blood flow may protect overperfusion of intracranial cerebral arteries during enhanced cardiac contractility and associated increases in cardiac output and perfusion pressure. Importantly, these findings suggest that the acute increase of blood perfusion attributable to dobutamine administration does not cause cerebral overperfusion or an associated risk of cerebral vascular damage.NEW & NOTEWORTHY A dobutamine-induced increase in cardiac contractility did not increase internal carotid artery blood flow despite an increase in cardiac output and arterial blood pressure. In contrast, external carotid artery blood flow and conductance increased. This external cerebral blood flow response may assist with protecting from overperfusion of intracranial blood flow.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-shi, Saitama, Japan;
| | - Gilbert Moralez
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe-shi, Saitama, Japan
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Michinari Hieda
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Steven A Romero
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Matthew N Cramer
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Manabu Shibasaki
- Department of Environmental Health, Nara Women's University, Nara-shi, Nara, Japan
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and
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Kawauchi K, Furuya S, Kikushima K, Tani S, Takahashi H, Iida K, Washio T, Niizuma S, Kobori M, Ashida T, Yagyu S, Matsumoto N, Hirayama A. P1564Do endothelial-dependent and -independent coronary microvascular dysfunction coexist in women with chest pain and unobstructed coronary arteries? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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