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Mehra R, Tjurmina OA, Ajijola OA, Arora R, Bolser DC, Chapleau MW, Chen PS, Clancy CE, Delisle BP, Gold MR, Goldberger JJ, Goldstein DS, Habecker BA, Handoko ML, Harvey R, Hummel JP, Hund T, Meyer C, Redline S, Ripplinger CM, Simon MA, Somers VK, Stavrakis S, Taylor-Clark T, Undem BJ, Verrier RL, Zucker IH, Sopko G, Shivkumar K. Research Opportunities in Autonomic Neural Mechanisms of Cardiopulmonary Regulation: A Report From the National Heart, Lung, and Blood Institute and the National Institutes of Health Office of the Director Workshop. JACC Basic Transl Sci 2022; 7:265-293. [PMID: 35411324 PMCID: PMC8993767 DOI: 10.1016/j.jacbts.2021.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/22/2022]
Abstract
This virtual workshop was convened by the National Heart, Lung, and Blood Institute, in partnership with the Office of Strategic Coordination of the Office of the National Institutes of Health Director, and held September 2 to 3, 2020. The intent was to assemble a multidisciplinary group of experts in basic, translational, and clinical research in neuroscience and cardiopulmonary disorders to identify knowledge gaps, guide future research efforts, and foster multidisciplinary collaborations pertaining to autonomic neural mechanisms of cardiopulmonary regulation. The group critically evaluated the current state of knowledge of the roles that the autonomic nervous system plays in regulation of cardiopulmonary function in health and in pathophysiology of arrhythmias, heart failure, sleep and circadian dysfunction, and breathing disorders. Opportunities to leverage the Common Fund's SPARC (Stimulating Peripheral Activity to Relieve Conditions) program were characterized as related to nonpharmacologic neuromodulation and device-based therapies. Common themes discussed include knowledge gaps, research priorities, and approaches to develop novel predictive markers of autonomic dysfunction. Approaches to precisely target neural pathophysiological mechanisms to herald new therapies for arrhythmias, heart failure, sleep and circadian rhythm physiology, and breathing disorders were also detailed.
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Key Words
- ACE, angiotensin-converting enzyme
- AD, autonomic dysregulation
- AF, atrial fibrillation
- ANS, autonomic nervous system
- Ach, acetylcholine
- CNS, central nervous system
- COPD, chronic obstructive pulmonary disease
- CSA, central sleep apnea
- CVD, cardiovascular disease
- ECG, electrocardiogram
- EV, extracellular vesicle
- GP, ganglionated plexi
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- HRV, heart rate variability
- LQT, long QT
- MI, myocardial infarction
- NE, norepinephrine
- NHLBI, National Heart, Lung, and Blood Institute
- NPY, neuropeptide Y
- NREM, non-rapid eye movement
- OSA, obstructive sleep apnea
- PAH, pulmonary arterial hypertension
- PV, pulmonary vein
- REM, rapid eye movement
- RV, right ventricular
- SCD, sudden cardiac death
- SDB, sleep disordered breathing
- SNA, sympathetic nerve activity
- SNSA, sympathetic nervous system activity
- TLD, targeted lung denervation
- asthma
- atrial fibrillation
- autonomic nervous system
- cardiopulmonary
- chronic obstructive pulmonary disease
- circadian
- heart failure
- pulmonary arterial hypertension
- sleep apnea
- ventricular arrhythmia
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Affiliation(s)
- Reena Mehra
- Cleveland Clinic, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Olga A. Tjurmina
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | - Rishi Arora
- Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | | | - Mark W. Chapleau
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | | | | | - Michael R. Gold
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - David S. Goldstein
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Beth A. Habecker
- Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - M. Louis Handoko
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - James P. Hummel
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | - Marc A. Simon
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- University of California-San Francisco, San Francisco, California, USA
| | | | - Stavros Stavrakis
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | | | - Richard L. Verrier
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - George Sopko
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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van Nieuwenhuizen BP, de Goede P, Tan HL, van den Born BJ, Kunst A. Is there an association between socioeconomic status and the degree of diurnal variation in heart rate? Int J Cardiol Cardiovasc Risk Prev 2021; 11:200118. [PMID: 34918012 PMCID: PMC8645920 DOI: 10.1016/j.ijcrp.2021.200118] [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] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Disruption in circadian rhythms is associated with cardiovascular disease and may play a role in socioeconomic differences in cardiovascular disease prevalence. However, it is unclear whether low SES is associated with a lower diurnal rhythm in autonomic activity markers. We investigated the association between SES and the amplitude of the daily fluctuation of heart rate. METHODS We included data of 450 participants of a HELIUS sub-study in Amsterdam, the Netherlands. Participants wore an Actiheart monitor (CamNtech), a chest-worn monitor which measures heart rate every 15 s for several days. Cosinor analysis was performed on the time series of heart rate within each participant. We analyzed the association between the cosinor parameters (amplitude, midline and peak time of the diurnal HR rhythm) and SES indicators (education, occupational class and a proxy of income) in multivariate linear regression models, adjusting for age, sex and ethnicity. RESULTS There was a clear diurnal rhythm in the average heart rates, with a peak between noon and 18:00 and a trough between 04:00 and 06:00. This rhythm was present for all categories of education, occupation and income proxy. The estimates for the cosinor parameters did not differ consistently and significantly between categories of education, occupation or income proxy. CONCLUSIONS We did not find any consistent evidence to support our hypothesis of a diminished amplitude in the diurnal variation of heart rate in individuals with lower SES. Future studies should explore SES differences in the diurnal variation in markers of autonomic activity other than heart rate.
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Affiliation(s)
| | - Paul de Goede
- Laboratory of Endocrinology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Gastroenterology, Endocrinology, and Metabolism, Amsterdam, the Netherlands
- Hypothalamic Integration Mechanisms Group, Netherlands Institute for Neuroscience (NIN), An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Hanno L. Tan
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
| | - Bert-Jan van den Born
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anton Kunst
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Sherman K, Woyach V, Eisenach JC, Hopp FA, Cao F, Hogan QH, Dean C. Heterogeneity in patterns of pain development after nerve injury in rats and the influence of sex. Neurobiol Pain 2021; 10:100069. [PMID: 34381929 PMCID: PMC8339380 DOI: 10.1016/j.ynpai.2021.100069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
The genesis of neuropathic pain is complex, as sensory abnormalities may differ between patients with different or similar etiologies, suggesting mechanistic heterogeneity, a concept that is largely unexplored. Yet, data are usually grouped for analysis based on the assumption that they share the same underlying pathogenesis. Sex is a factor that may contribute to differences in pain responses. Neuropathic pain is more prevalent in female patients, but pre-clinical studies that can examine pain development in a controlled environment have typically failed to include female subjects. This study explored patterns of development of hyperalgesia-like behavior (HLB) induced by noxious mechanical stimulation in a neuropathic pain model (spared nerve injury, SNI) in both male and female rats, and autonomic dysfunction that is associated with chronic pain. HLB was analyzed across time, using both discrete mixture modeling and rules-based longitudinal clustering. Both methods identified similar groupings of hyperalgesia trajectories after SNI that were not evident when data were combined into groups by sex only. Within the same hyperalgesia development group, mixed models showed that development of HLB in females was delayed relative to males and reached a magnitude similar to or higher than males. The data also indicate that sympathetic tone (as indicated by heart rate variability) drops below pre-SNI level before or at the onset of development of HLB. This study classifies heterogeneity in individual development of HLB and identifies sexual dimorphism in the time course of development of neuropathic pain after nerve injury. Future studies addressing mechanisms underlying these differences could facilitate appropriate pain treatments.
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Affiliation(s)
- Katherine Sherman
- Research Division, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, United States
| | - Victoria Woyach
- Research Division, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, United States
- Department of Anesthesiology, Medical College of Wisconsin and Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53226, United States
| | - James C. Eisenach
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Francis A. Hopp
- Research Division, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, United States
| | - Freddy Cao
- College of Nursing, University of Wisconsin – Milwaukee, Milwaukee, WI 53222, United States
| | - Quinn H. Hogan
- Research Division, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, United States
- Department of Anesthesiology, Medical College of Wisconsin and Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53226, United States
| | - Caron Dean
- Research Division, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, United States
- Department of Anesthesiology, Medical College of Wisconsin and Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53226, United States
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Waldron NH, Fudim M, Mathew JP, Piccini JP. Neuromodulation for the Treatment of Heart Rhythm Disorders. JACC Basic Transl Sci 2019; 4:546-562. [PMID: 31468010 PMCID: PMC6712352 DOI: 10.1016/j.jacbts.2019.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 12/13/2022]
Abstract
Derangement of autonomic nervous signaling is an important contributor to cardiac arrhythmogenesis. Modulation of autonomic nervous signaling holds significant promise for the prevention and treatment of cardiac arrhythmias. Further clinical investigation is necessary to establish the efficacy and safety of autonomic modulatory therapies in reducing cardiac arrhythmias.
There is an increasing recognition of the importance of interactions between the heart and the autonomic nervous system in the pathophysiology of arrhythmias. These interactions play a role in both the initiation and maintenance of arrhythmias and are important in both atrial and ventricular arrhythmia. Given the importance of the autonomic nervous system in the pathophysiology of arrhythmias, there has been notable effort in the field to improve existing therapies and pioneer additional interventions directed at cardiac-autonomic targets. The interventions are targeted to multiple and different anatomic targets across the neurocardiac axis. The purpose of this review is to provide an overview of the rationale for neuromodulation in the treatment of arrhythmias and to review the specific treatments under evaluation and development for the treatment of both atrial fibrillation and ventricular arrhythmias.
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Key Words
- AERP, atrial effective refractory period
- AF, atrial fibrillation
- AGP, autonomic ganglionic plexus
- ANS, autonomic nervous system
- CABG, coronary artery bypass grafting
- HRV, heart rate variability
- ICD, implantable cardioverter-defibrillator
- LLVNS, low-level vagal nerve stimulation
- OSA, obstructive sleep apnea
- POAF, post-operative atrial fibrillation
- PVI, pulmonary vein isolation
- RDN, renal denervation
- SCS, spinal cord stimulation
- SGB, stellate ganglion blockade
- SNS, sympathetic nervous system
- VF, ventricular fibrillation
- VNS, vagal nerve stimulation
- VT, ventricular tachycardia
- arrhythmia
- atrial fibrillation
- autonomic nervous system
- ganglionated plexi
- neuromodulation
- ventricular arrhythmias
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Affiliation(s)
- Nathan H Waldron
- Department of Anesthesia, Duke University Medical Center, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, North Carolina.,Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
| | - Joseph P Mathew
- Department of Anesthesia, Duke University Medical Center, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Durham, North Carolina.,Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
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Khaliulin I, Fleishman AN, Shumeiko NI, Korablina T, Petrovskiy SA, Ascione R, Suleiman MS. Neuro-autonomic changes induced by remote ischemic preconditioning (RIPC) in healthy young adults: Implications for stress. Neurobiol Stress 2019; 11:100189. [PMID: 31388518 PMCID: PMC6675953 DOI: 10.1016/j.ynstr.2019.100189] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 01/12/2023] Open
Abstract
The mechanisms underlying the protective effects of remote ischemic preconditioning (RIPC) are not presently clear. Recent studies in experimental models suggest the involvement of the autonomic nervous system (ANS) in cardioprotection. The aim of this study was to investigate the changes in ANS in healthy young volunteers divided into RIPC (n = 22) or SHAM (n = 18) groups. RIPC was induced by 1 cycle of 4 min inflation/5 min deflation followed by 2 cycles of 5 min inflation/5 min deflation of a cuff placed on the upper left limb. The study included analysis of heart rate (HR), blood pressure (BP), heart rate variability (HRV), measurements of microcirculation and porphyrin fluorescence in the limb before and after the RIPC. RIPC caused reactive hyperemia in the limb and reduced blood porphyrin level. A mental load (serial sevens test) and mild motor stress (hyperventilation) were performed on all subjects before and after RIPC or corresponding rest in the SHAM group. Reduction of HR occurred during the experiments in both RIPC and SHAM groups reflecting RIPC-independent adaptation of the subjects to the experimental procedure. However, in contrast to the SHAM group, RIPC altered several of the spectral indices of HRV during the serial sevens test and hyperventilation. This was expressed predominantly as an increase in power of the very low-frequency band of the spectrum, increased values of detrended fluctuation analysis and weakening of correlation between the HRV parameters and HR. In conclusion, RIPC induces changes in the activity of ANS that are linked to stress resistance. Brief ischemia/reperfusion episodes of distant organs (RIPC) protect other organs. Mechanism of RIPC is not known but it involves neuronal activity. RIPC applied to volunteers was interspersed with mild mental and physical stress. RIPC was confirmed by hyperemia in the limb and metabolic response to hypoxia. Heart rate variability shows that RIPC modulates ANS to increase stress resistance.
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Key Words
- ANS, autonomic nervous system
- Autonomic nervous system
- BP, blood pressure
- DBP, diastolic blood pressure
- DFA, detrended fluctuation analysis
- HF, high frequency
- HR, heart rate
- HRV, heart rate variability
- Heart rhythm variability
- LF, low frequency
- RIPC, remote ischaemic preconditioning
- Remote ischemic preconditioning
- SBP, systolic blood pressure
- VLF, very low frequency
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Affiliation(s)
- Igor Khaliulin
- Bristol Medical School, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Arnold N Fleishman
- Research Institute for Complex Problems of Hygiene and Occupational Diseases, 23 Ulitsa Kutuzova, Novokuznetsk, Kemerovo Oblast, 654041, Russia
| | - Nadezhda I Shumeiko
- Research Institute for Complex Problems of Hygiene and Occupational Diseases, 23 Ulitsa Kutuzova, Novokuznetsk, Kemerovo Oblast, 654041, Russia
| | - TatyanaV Korablina
- Information Technology Department, Siberian State Industrial University, Ulitsa Kirova, 42, Novokuznetsk, Kemerovo Oblast, 654007, Russia
| | - Stanislav A Petrovskiy
- Research Institute for Complex Problems of Hygiene and Occupational Diseases, 23 Ulitsa Kutuzova, Novokuznetsk, Kemerovo Oblast, 654041, Russia
| | - Raimondo Ascione
- Bristol Medical School, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - M-Saadeh Suleiman
- Bristol Medical School, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW, UK
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Shin KM, Park JE, Yook TH, Kim JU, Kwon O, Choi SM. Moxibustion for prehypertension and stage I hypertension: a pilot randomized controlled trial. Integr Med Res 2019; 8:1-7. [PMID: 30596012 PMCID: PMC6309023 DOI: 10.1016/j.imr.2018.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/28/2018] [Revised: 11/06/2018] [Accepted: 11/19/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Prehypertension and hypertension are associated with cardiovascular disease, ischemic heart disease, and stroke morbidity. The purpose of this study is to evaluate the effectiveness and safety of moxibustion in patients with prehypertension or hypertension. METHODS Forty-five subjects with prehypertension or stage I hypertension were randomized into three groups: moxibustion treatment group A (2 sessions/week for 4 weeks), moxibustion treatment group B (3 sessions/week for 4 weeks), and control group (nontreated group). The primary outcome measure was the change in blood pressure after 4 weeks of treatment. Safety was assessed at every visit. RESULTS There were no significant differences in systolic blood pressure (SBP) or diastolic blood pressure (DBP) among three groups after 4 weeks of treatment (p = 0.4798 and p = 0.3252, respectively). In treatment group B, there was a significant decrease in SBP and DBP from baseline to 4 weeks of treatment (mean difference (MD) -9.55; p = 0.0225, MD -7.55; p = 0.0098, respectively). There were no significant differences among groups in secondary outcome measures after 4 weeks of treatment. Six adverse events (AEs) in the treatment group A and 12 AEs in the treatment group B occurred related to the moxibustion treatment. CONCLUSION In conclusion, the results of this study show that moxibustion (3 sessions/week for 4 weeks) might lower blood pressure in patients with prehypertension or stage I hypertension and treatment frequency might affect effectiveness of moxibustion in BP regulation. Further randomized controlled trials with a large sample size on prehypertension and hypertension should be conducted. TRIAL REGISTRATION This study was registered with the 'Clinical Research Information Service (CRIS)', Republic of Korea (KCT0000469), and the protocol for this study was presented orally at the 15th International Council of Medical Acupuncture and Related Techniques (ICMART) in Athens, 25-27 May 2012.
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Key Words
- AE, adverse event
- BMI, body mass index
- BP, blood pressure
- CI, confidence interval
- DBP, diastolic blood pressure
- EQ-5D, EuroQol-5 Dimensions
- FSS, Fatigue Severity Scale
- HRV, heart rate variability
- Hypertension
- MD, mean difference
- Moxibustion
- NDI, neck disability index
- PSQI, Pittsburgh Sleep Quality Index
- Prehypertension
- RCT, randomized controlled trial
- SAE, serious adverse event
- SBP, systolic blood pressure
- SRI-MF, Modified Form of the Stress Response Inventory
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Affiliation(s)
- Kyung-Min Shin
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Ji-Eun Park
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Tae-Han Yook
- Department of Acupuncture & Moxibustion Medicine, Korean Medicine Hospital of Woosuk University, Jeonju, South Korea
| | - Jong-Uk Kim
- Department of Acupuncture & Moxibustion Medicine, Korean Medicine Hospital of Woosuk University, Jeonju, South Korea
| | - Ojin Kwon
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Sun-Mi Choi
- Korea Institute of Oriental Medicine, Daejeon, South Korea
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Toi N, Inaba M, Kurajoh M, Morioka T, Hayashi N, Hirota T, Miyaoka D, Emoto M, Yamada S. Improvement of glycemic control by treatment for insomnia with suvorexant in type 2 diabetes mellitus. J Clin Transl Endocrinol 2018; 15:37-44. [PMID: 30619717 PMCID: PMC6306692 DOI: 10.1016/j.jcte.2018.12.006] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/12/2018] [Accepted: 12/17/2018] [Indexed: 12/25/2022]
Abstract
Introduction Acute and chronic insomnia can exacerbate type 2 diabetes mellitus (T2DM). We investigated suvorexant (an anti-insomnia drug that targets the orexin system) effects on sleep architecture and glucose metabolism in T2DM patients with insomnia. Materials and methods This 7 day open-label, single-arm, intervention trial included 18 subjects with T2DM and insomnia. After 1 day acclimatization, daily glucose levels, sleep architecture, and autonomic nervous function were evaluated by continuous glucose monitoring (CGM), single-channel electroencephalography, and accelerometry, respectively. Results Suvorexant treatment for 3 days significantly increased total sleep time and sleep efficiency, with partial suppression of sympathetic nerve activity. CGM-measured 24 h mean glucose level decreased significantly from 157.7 ± 22.9 to 152.3 ± 17.8 mg/dL, especially in the early glucose surge after the midnight nadir (from 28.3 ± 15.0 to 18.2 ± 9.9 mg/dL), and until supper with a significant improvement in homeostasis model assessment of insulin resistance from 4.0 ± 2.8 to 2.9 ± 1.6, respectively. Conclusions Suvorexant treatment for insomnia of subjects with T2DM significantly improved CGM-measured daily glycemic control, which was associated with changes in sympathomimetic tone and/or improved insulin sensitivity. The amelioration of insomnia may therefore be a target for improving glycemic control in T2DM patients with insomnia.
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Key Words
- AHI, Apnea–Hypopnea Index
- AUC, area under the curve
- Autonomic nervous function
- BMI, body mass index
- CGM, continuous glucose monitoring
- CPR, C-peptide immunoreactivity
- CVR-R, coefficient of variation of RR intervals
- DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
- Dawn phenomenon
- EEG, electroencephalography
- Glycemic control
- HOMA-IR, homeostasis model assessment of insulin resistance
- HR, heart rate
- HRV, heart rate variability
- HbA1c, glycated hemoglobin A1c
- IQR, interquartile range
- IRI, immunoreactive insulin
- Insulin resistance
- PSQI, Pittsburgh Sleep Quality Index
- REM, rapid eye movement
- SAS, Sleep Apnea Syndrome
- SD, standard deviation
- SDNN, standard deviation of the NN (i.e., R-R) intervals
- T2DM, type 2 diabetes mellitus
- Therapy for insomnia
- Type 2 diabetes mellitus
- bpm, beats per minute
- eGFR, estimated glomerular filtration ratio
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Affiliation(s)
- Norikazu Toi
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Masafumi Kurajoh
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Tomoaki Morioka
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Noriyuki Hayashi
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Tomoe Hirota
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Daichi Miyaoka
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Shinsuke Yamada
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Yoshida K, Saku K, Kamada K, Abe K, Tanaka-Ishikawa M, Tohyama T, Nishikawa T, Kishi T, Sunagawa K, Tsutsui H. Electrical Vagal Nerve Stimulation Ameliorates Pulmonary Vascular Remodeling and Improves Survival in Rats With Severe Pulmonary Arterial Hypertension. ACTA ACUST UNITED AC 2018; 3:657-671. [PMID: 30456337 PMCID: PMC6234524 DOI: 10.1016/j.jacbts.2018.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 05/14/2018] [Revised: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 11/29/2022]
Abstract
Autonomic imbalance has been documented in patients with PAH. Electrical VNS is known to restore autonomic balance and improve heart failure. This study aimed to elucidate the therapeutic effects of VNS on severe PAH in a rat model. VNS significantly restored autonomic balance, decreased mean pulmonary arterial pressure, attenuated pulmonary vascular remodeling, and preserved right ventricular function. In addition, VNS markedly improved the survival of rats with PAH. Our findings may contribute greatly to the development of device therapy for PAH and widen the clinical applicability of VNS.
This study aimed to elucidate the therapeutic effects of electrical vagal nerve stimulation (VNS) on severe pulmonary arterial hypertension in a rat model. In a pathophysiological study, VNS significantly restored autonomic balance, decreased mean pulmonary arterial pressure, attenuated pulmonary vascular remodeling, and preserved right ventricular function. In a survival study, VNS significantly improved the survival rate in both the prevention (VNS from 0 to 5 weeks after a SU5416 injection) and treatment (VNS from 5 to 10 weeks) protocols. Thus, VNS may serve as a novel therapeutic strategy for pulmonary arterial hypertension.
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Key Words
- BNP, brain natriuretic peptide
- HF, high-frequency
- HRV, heart rate variability
- IL, interleukin
- MCP, monocyte chemotactic protein
- NE, norepinephrine
- NO, nitric oxide
- PA, pulmonary artery
- PAH, pulmonary arterial hypertension
- PAP, pulmonary arterial pressure
- PVR, pulmonary vascular resistance
- RV, right ventricular
- RVEDP, right ventricular end-diastolic pressure
- SS, sham-stimulated
- VNS, vagal nerve stimulation
- autonomic imbalance
- eNOS, endothelial nitric oxide synthase
- mRNA, messenger ribonucleic acid
- pulmonary arterial hypertension
- pulmonary vascular remodeling
- vagal nerve stimulation
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Affiliation(s)
- Keimei Yoshida
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Keita Saku
- Department of Advanced Risk Stratification for Cardiovascular Diseases, Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
- Address for correspondence: Dr. Keita Saku, Department of Advanced Risk Stratification for Cardiovascular Diseases, Center for Disruptive Cardiovascular Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Kazuhiro Kamada
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Mariko Tanaka-Ishikawa
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takeshi Tohyama
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takuya Nishikawa
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takuya Kishi
- Department of Advanced Risk Stratification for Cardiovascular Diseases, Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
| | - Kenji Sunagawa
- Department of Therapeutic Regulation of Cardiovascular Homeostasis, Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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Karimi Moridani M, Haghighi Bardineh Y. Presenting an efficient approach based on novel mapping for mortality prediction in intensive care unit cardiovascular patients. MethodsX 2018; 5:1291-8. [PMID: 30364735 DOI: 10.1016/j.mex.2018.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/05/2018] [Indexed: 01/08/2023] Open
Abstract
Intensive care unit (ICU) experienced and skillful people in this field should be employed because the equipment, facilities, and admitted patients have more special conditions than other departments. Our goal provides the best quality according to the condition each patient and prevent many unnecessary costs for preventive treatment. In this paper, the proposed system will first receive the patient's vital signs, which are recorded by the ICU monitoring. After the necessary processing, in case of observing changes in the normal state, risk alarms are transmitted to the nursing station so that nurses become aware of this condition and take all equipment to return the patient to normal condition and prevent his death. The applied graph in this study examines patients at any moment and displays the patient's future condition in a schematic manner after precise analyses. In this algorithm, after calculating the R-R intervals in the electrocardiogram signal, RRIs are thrown into a risk plot (RP) by a projectile. Given the amount of projectile RRI, one of the stairs can host that amount. After a few moments by springs embedded under the stairs, the drain of RRIs is done by the kinetic energy stored in the springs towards the valley of life. If the accumulation of quantities in a stair is too much, the spring will not be able to project those RRIs. By examining this situation, we will introduce an index to determine the risk of death for all patients. The results of this paper show that when a person is in normal condition, there is no density in a certain stair and the ball or the projected RRIs are not limited to a stair. In general, the results of this paper show that the lower amount of RRI dispersion in the RP leads to greater risk of entry into the death range and as this amount decrease, an immediate consideration is required. In conclusion, if the precise prediction of the future condition of ICU patients is available to nurses and doctors, more facilities and equipment could be provided to save their lives. •We focused on nonlinear methods with new aspects to extract mentioned dynamics.•This method can reduce the number of ICU nurses and give the special facilities for high-risk patients.•Our results confirm that it is possible to predict mortality based on the dynamical characteristics of HRV.
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10
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Narkiewicz K, Ratcliffe LEK, Hart EC, Briant LJB, Chrostowska M, Wolf J, Szyndler A, Hering D, Abdala AP, Manghat N, Burchell AE, Durant C, Lobo MD, Sobotka PA, Patel NK, Leiter JC, Engelman ZJ, Nightingale AK, Paton JFR. Unilateral Carotid Body Resection in Resistant Hypertension: A Safety and Feasibility Trial. ACTA ACUST UNITED AC 2016; 1:313-324. [PMID: 27766316 PMCID: PMC5063532 DOI: 10.1016/j.jacbts.2016.06.004] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [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: 04/02/2016] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 11/17/2022]
Abstract
Animal and human data indicate pathological afferent signaling emanating from the carotid body that drives sympathetically mediated elevations in blood pressure in conditions of hypertension. This first-in-man, proof-of-principle study tested the safety and feasibility of unilateral carotid body resection in 15 patients with drug-resistant hypertension. The procedure proved to be safe and feasible. Overall, no change in blood pressure was found. However, 8 patients showed significant reductions in ambulatory blood pressure coinciding with decreases in sympathetic activity. The carotid body may be a novel target for treating an identifiable subpopulation of humans with hypertension.
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Key Words
- ABP, ambulatory blood pressure
- ASBP, ambulatory systolic blood pressure
- BRS, baroreceptor reflex sensitivity
- CB, carotid body
- HRV, heart rate variability
- HVR, hypoxic ventilatory response
- MSNA, muscle sympathetic nerve activity
- OBP, office blood pressure
- OSBP, office systolic blood pressure
- afferent drive
- baroreceptor reflex
- hypertension
- hypoxia
- peripheral chemoreceptor
- sympathetic nervous system
- uCB, unilateral carotid body
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Affiliation(s)
- Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Laura E K Ratcliffe
- CardioNomics Research Group, Clinical Research & Imaging Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Emma C Hart
- CardioNomics Research Group, Clinical Research & Imaging Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, United Kingdom
| | - Linford J B Briant
- CardioNomics Research Group, Clinical Research & Imaging Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Marzena Chrostowska
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Wolf
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Anna Szyndler
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Ana P Abdala
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, United Kingdom
| | - Nathan Manghat
- CardioNomics Research Group, Clinical Research & Imaging Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Amy E Burchell
- CardioNomics Research Group, Clinical Research & Imaging Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Claire Durant
- CardioNomics Research Group, Clinical Research & Imaging Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Melvin D Lobo
- NIHR Barts Cardiovascular Biomedical Research Unit, William Harvey Research Institute, QMUL, Charterhouse Square, London, United Kingdom
| | - Paul A Sobotka
- Department of Internal Medicine, Division of Cardiovascular Diseases, The Ohio State University, Columbus, Ohio
| | - Nikunj K Patel
- Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | - James C Leiter
- Department of Physiology and Neurobiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | | | - Angus K Nightingale
- CardioNomics Research Group, Clinical Research & Imaging Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Julian F R Paton
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, United Kingdom
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11
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Makovac E, Meeten F, Watson DR, Garfinkel SN, Critchley HD, Ottaviani C. Neurostructural abnormalities associated with axes of emotion dysregulation in generalized anxiety. Neuroimage Clin 2015; 10:172-81. [PMID: 26759791 PMCID: PMC4683456 DOI: 10.1016/j.nicl.2015.11.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/25/2015] [Accepted: 11/29/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite the high prevalence of generalized anxiety disorder (GAD) and its negative impact on society, its neurobiology remains obscure. This study characterizes the neurostructural abnormalities associated with key symptoms of GAD, focusing on indicators of impaired emotion regulation (excessive worry, poor concentration, low mindfulness, and physiological arousal). METHODS These domains were assessed in 19 (16 women) GAD patients and 19 healthy controls matched for age and gender, using questionnaires and a low demand behavioral task performed before and after an induction of perseverative cognition (i.e. worry and rumination). Continuous pulse oximetry was used to measure autonomic physiology (heart rate variability; HRV). Observed cognitive and physiological changes in response to the induction provided quantifiable data on emotional regulatory capacity. Participants underwent structural magnetic resonance imaging; voxel-based morphometry was used to quantify the relationship between gray matter volume and psychological and physiological measures. RESULTS Overall, GAD patients had lower gray matter volume than controls within supramarginal, precentral, and postcentral gyrus bilaterally. Across the GAD group, increased right amygdala volume was associated with prolonged reaction times on the tracking task (indicating increased attentional impairment following the induction) and lower scores on the 'Act with awareness' subscale of the Five Facets Mindfulness Questionnaire. Moreover in GAD, medial frontal cortical gray matter volume correlated positively with the 'Non-react mindfulness' facet. Lastly, smaller volumes of bilateral insula, bilateral opercular cortex, right supramarginal and precentral gyri, anterior cingulate and paracingulate cortex predicted the magnitude of autonomic change following the induction (i.e. a greater decrease in HRV). CONCLUSIONS Results distinguish neural structures associated with impaired capacity for cognitive, attentional and physiological disengagement from worry, suggesting that aberrant competition between these levels of emotional regulation is intrinsic to symptom expression in GAD.
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Key Words
- ACC, anterior cingulate cortex
- Attentional deficit
- BDI, Beck Depression Inventory
- DLPFC, dorsolateral prefrontal cortex
- DMPFC, dorsomedial prefrontal cortex
- FFMQ, Five Facets Mindfulness Questionnaire
- GAD, generalized anxiety disorder
- Generalized anxiety disorder
- HC, healthy controls
- HRV, heart rate variability
- Heart rate variability
- IBI, Inter-beat-intervals
- ICV, intra-cranial volume
- MNI, Montreal Neurological Institute
- Magnetic resonance imaging
- Mindfulness
- PCC, posterior cingulate cortex
- PFC, prefrontal cortex
- Perseverative cognition
- RMSSD, root mean square successive difference
- ROI, region-of-interest
- RT, reaction times
- SCID, Structured Clinical Interview for DSMIV
- STAI, State-Trait Anxiety Inventory
- VAS, visual-analogue scales
- VBM, voxel-based morphometry
- mOFC, medial orbitofrontal cortex
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Affiliation(s)
- Elena Makovac
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Frances Meeten
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Kings College London, London, UK
| | - David R Watson
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Sarah N Garfinkel
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Sackler Centre for Consciousness Science, University of Sussex, UK
| | - Hugo D Critchley
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Sackler Centre for Consciousness Science, University of Sussex, UK; Sussex Partnership NHS Foundation Trust, Sussex, UK
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Chanavirut R, Makarawate P, Macdonald IA, Leelayuwat N. Autonomic and cardio-respiratory responses to exercise in Brugada Syndrome patients. J Arrhythm 2016; 32:426-32. [PMID: 27761168 DOI: 10.1016/j.joa.2015.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/29/2015] [Accepted: 09/03/2015] [Indexed: 01/09/2023] Open
Abstract
Background Imbalances of the autonomic nervous (ANS), the cardiovascular system, and ionics might contribute to the manifestation of The Brugada Syndrome (BrS). Thus, this study has aimed to investigate the cardio-respiratory fitness and the responses of the ANS both at rest and during a sub-maximal exercise stress test, in BrS patients and in gender-matched and age-matched healthy sedentary controls. Methods Eleven BrS patients and 23 healthy controls were recruited in Khon Kaen, Thailand. They performed an exercise test on a cycle ergometer, and during the exercise, expired gas samples and electrocardiograms were collected. Blood glucose and electrolyte concentrations were analyzed before and after exercise. Then the heart rate variability (HRV) and the heart rate recovery (HRR) were analyzed from the electrocardiograms. Results The BrS patients showed a higher parasympathetic activation during exercise recovery than baseline. They had a smaller level of sympathetic activation during the period of exercise recovery than the controls did. They also showed a significantly lower peak HR, HRR, and peak oxygen consumption than the controls (p<0.05). All subjects had a significantly lower percentage of peak oxygen consumption and respiratory exchange ratio during low-intensity (p<0.01) and moderate-intensity (p<0.05) exercise than during high-intensity exercise. The BrS patients had mild hyperkalemia which is reduced according to the exercise. Conclusion Thai BrS patients had a more rapid rate of restoration of the parasympathetic and smaller level of sympathetic activation after exercise. They had mild hyperkalemia which is reduced according to the exercise. Furthermore, they exhibited impaired cardio-respiratory fitness.
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Key Words
- ANS, autonomic nervous system
- BrS, total Brugada Syndrome
- BrS-D, patients who took anti-arrhythmic drugs
- BrS-ND, patients who did not take anti-arrhythmic drugs
- Brugada Syndrome
- CHO, carbohydrate.
- ECG, electrocardiogram
- Exercise
- HF, high frequency
- HR, heart rate
- HRR, heart rate recovery
- HRV, heart rate variability
- Heart rate recovery
- Heart rate variability
- ICD, implantable cardioverter-defibrillator
- K+, potassium
- LF, low frequency
- O2 peak, peak oxygen consumption
- Potassium
- RER, respiratory exchange ratio
- RMSSD, the square root of the mean of the sum of the squares of differences between adjacent normal to normal intervals
- SCD, sudden cardiac death
- SDNN, standard deviation of all normal sinus RR intervals
- VF, ventricular fibrillation
- VT, ventricular tachycardia
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