scholarly journals 346 Baroreflex sensitivity and autonomic function in Takotsubo syndrome long after the acute phase

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Martina Zinelli ◽  
Davide Lazzeroni ◽  
Luca Moderato ◽  
Claudio Stefano Centorbi ◽  
Matteo Bini ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Acute Phase ◽  
Baroreflex Sensitivity ◽  
Autonomic Function ◽  
Left Ventricular ◽  
Sympathetic Tone ◽  
Coronary Syndrome ◽  
History Of ◽  
Acute Event

Abstract Aims Takotsubo Syndrome (TS) occurs as an acute coronary syndrome (ACS) characterized by severe left ventricular (LV) dysfunction that typically recovers spontaneously within days or weeks and in the absence of obstructive coronary artery disease. Although during the acute phase it is well documented that an exaggerated sympathetic tone plays a central role in the development of TS, whether an impaired sympatho-vagal balance may persist long after the acute phase, despite the recovery of left ventricular function, is still an open issue. Interestingly, recent evidences suggest that an impairment in central autonomic network not only persist long after the acute event but also may be pre-existent before the acute onset of TS. The Aim of the study was to investigate whether an impairment of the autonomic function is still present long after a TS event. Methods and results We evaluated 67 patients (91% female, mean age 66 ± 8 years) divided into three groups: 24 with a history of TS (1 year after acute event), 21 subjects with a previous history of acute coronary syndrome (ACS) and complete LV ejection fraction recovery (1 year after acute event) and 22 age- and gender-matched healthy subjects. All patients underwent a non-invasive beat-to-beat arterial blood pressure and heart rate recording (short term: 5 min), after at least 3 days of β-blockers wash-out, to obtain heart rate variability (HRV) and spontaneous baroreflex sensitivity (sBRS) data. An overall autonomic dysfunction was found in both TS and ACS groups compared to controls. In particular, a lower heart rate variability, expressed as lower SDNN, has been found in TS and ACS groups compared to controls (31 ± 12 vs. 25 ± 11 vs. 41 ± 22; P = 0.006—Figure A) as a consequence of blunted vagal tone, expressed as lower RMSSD (20 ± 12 vs. 19 ± 11 vs. 40 ± 37; P = 0.007—Figure B) and higher sympathetic tone, expressed as higher LF/HF ratio (P = 0.007 Figure C) which was found to be higher in TS even when compared to ACS (TS: 3.5 ± 2.5 vs. ACS: 2.1 ± 1.7; P = 0.011). Moreover, fractal analysis of HRV showed higher complexity of heart rate regulation, expressed as higher fractal dimension (DFA 1.48 ± 0.06 vs. 1.53 ± 0.05 vs. 1.40 ± 0.10; P < 0.0001—Figure D), in both TS and ACS compared to controls. Interestingly, spontaneous BRS showed the lowest values in the TS group (sSBP: 5.6 ± 2.6 vs. 7.5 ± 3.0 vs. 12.1 ± 11.9; P = 0.027—Figure E), associated with highest levels of sympathetic peripheral control of systolic blood pressure (SBP), expressed as LF-BRS (13.7 ± 9.6 vs. 8.3 ± 5.2 ± 6.8 ± 5.8; P = 0.008—Figure F). Conclusions An autonomic dysfunction, characterized by a hyper-sympathetic tone, reduced baroreflex sensitivity and increased peripheral adrenergic control of blood pressure, persists in TS patients long after the acute phase.

scholarly journals Effect of short-acting b--blockers on heart rate and blood pressure in patients with acute coronary syndrome during percutaneous and coronary intervention

2021 ◽  
Vol 4 (2) ◽  
pp. 36-44
Author(s):  
L Rasputina ◽  
D Didenko ◽  
A Solomonchyk
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Heart Rate Reduction ◽  
Rate Reduction ◽  
Coronary Syndrome ◽  
History Of

Background. The use of b- blockers in acute coronary syndrome (ACS) is recommended for all patients, who has not contraindications. The study of the effects of esmolol during percutaneous coronary intervention (PCI) remains relevant. Objective. To evaluate the features of the effect of esmolol (Biblock, “YURiA-PHARM”) on heart rate and blood pressure in patients with ACS during PCI.Materials and methods. The study included 30 patients, 15 men and 15 women, who were hospitalized in a specialized cardiology department with ACS with elevation of the ST segment. All patients underwent a general clinical examination, ECG recording in 12 leads, PCI according to the standard protocol with ECG and blood pressure monitoring. All patients were given infusion of esmolol before the standard therapy. The level of heart rate reduction, systolic blood pressure (SBP), diastolic blood pressure (DBP), the correlation of heart rate reduction during esmolol infusion with the clinical and functional parameters of patients and the degree of coronary artery (CA) damage were analyzed.Results. Decreased heart rate and blood pressure during infusion of esmolol in all patients. Before the infusion, the heart rate av-eraged (109.8 ± 4.0) beats per minute. After the infusion – (92.8 ± 3.2) beats per minute, (p < 0.001) with an average duration of infusion (18.2 ± 2.3) minutes. The decrease in SBP levels during infusion occurred on average by (22.8 ± 2.5) mm Hg, DBP – by (16.0 ± 2.1) mm Hg, no patient had hypotension. According to the results of correlation analysis, it was found that the decrease in heart rate with the use of esmolol has a correlation with the average age of patients (r = -0.47, p = 0.0012), with the presence of multivascular coronary artery disease (r = -0.38, p = 0.002). Weaker negative correlation was found with the initial level of SBP (r = -0.28, p = 0.015), the presence of a history of myocardial infarction (r = -0.27, p = 0.005), the presence of signs of left ventricular hypertrophy (LVH) on the ECG (r = -0.22, p = 0.008), and a history of arterial hypertension that was not treated according to current recommendations (r = -0.21, p = 0.032).Conclusions. The use of esmolol solution in patients with ACS who have supraventricular tachycardia and elevated blood pressure during PCI can improve control of heart rate, SBP and DBP, a significant decrease is observed after 10 minutes of dose titration. Careful titration of esmolol solution and monitoring of ECG and blood pressure revealed no side effects, including bradycardia and hypotension, which indicates a high safety profile of the drug.

scholarly journals Sex differences in baroreflex sensitivity, heart rate variability, and end organ damage in the TGR(mRen2)27 rat

2011 ◽  
Vol 301 (4) ◽  
pp. H1540-H1550 ◽  
Author(s):  
Megan S. Johnson ◽  
Vincent G. DeMarco ◽  
Cheryl M. Heesch ◽  
Adam T. Whaley-Connell ◽  
Rebecca I. Schneider ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Sex Differences ◽  
Baroreflex Sensitivity ◽  
Organ Damage ◽  
Left Ventricular ◽  
Loop Analysis ◽  
Poincaré Plot ◽  
End Organ Damage

The aim of this investigation was to evaluate sex differences in baroreflex and heart rate variability (HRV) dysfunction and indexes of end-organ damage in the TG(mRen2)27 (Ren2) rat, a model of renin overexpression and tissue renin-angiotensin-aldosterone system overactivation. Blood pressure (via telemetric monitoring), blood pressure variability [BPV; SD of systolic blood pressure (SBP)], spontaneous baroreflex sensitivity, HRV [HRV Triangular Index (HRV-TI), standard deviation of the average NN interval (SDNN), low and high frequency power (LF and HF, respectively), and Poincaré plot analysis (SD1, SD2)], and cardiovascular function (pressure-volume loop analysis and proteinuria) were evaluated in male and female 10-wk-old Ren2 and Sprague Dawley rats. The severity of hypertension was greater in Ren2 males (R2-M) than in Ren2 females (R2-F). Increased BPV, suppression of baroreflex gain, decreased HRV, and associated end-organ damage manifested as cardiac dysfunction, myocardial remodeling, elevated proteinuria, and tissue oxidative stress were more pronounced in R2-M compared with R2-F. During the dark cycle, HRV-TI and SDNN were negatively correlated with SBP within R2-M and positively correlated within R2-F; within R2-M, these indexes were also negatively correlated with end-organ damage [left ventricular hypertrophy (LVH)]. Furthermore, within R2-M only, LVH was strongly correlated with indexes of HRV representing predominantly vagal (HF, SD1), but not sympathetic (LF, SD2), variability. These data demonstrated relative protection in females from autonomic dysfunction and end-organ damage associated with elevated blood pressure in the Ren2 model of hypertension.

scholarly journals 345 Blood pressure and autonomic function in essential hypertension: comparative evaluation of 24-hour heart rate variability and blood pressure

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Vanessa Pivetti ◽  
Davide Lazzeroni ◽  
Luca Moderato ◽  
Claudio Stefano Centorbi ◽  
Matteo Bini ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Autonomic Function ◽  
Linear Complexity ◽  
Complexity Analysis ◽  
Beta Blockers ◽  
Sympathetic Tone ◽  
Night Time ◽  
Non Linear

Abstract Aims Arterial hypertension (AHT) represents the leading cause of cardiovascular disease (CVD) and premature death worldwide. Essential AHT accounts for 95% of all cases of hypertension; although the aetiology of essential AHT is still largely unknown, a pivotal role of autonomic nervous system has been proposed and demonstrated. Both excessive sympathetic tone and vagal withdrawal, that define autonomic dysfunction, has been associated with essential AHT. The aim of our study was to investigate the relationship between blood pressure and autonomic function in essential hypertension; this was done comparing 24 h heart rate variability and 24 h blood pressure data, simultaneously collected, in a population of essential AHT subjects. Methods A prospective registry of 179 consecutive not selected essential AHT patients were considered in the present study. All patients underwent cardiac evaluation at the Primary and Secondary Cardiovascular Prevention Unit of the Don Gnocchi Foundation of Parma. All subjects underwent 24 h ECG monitoring, and 24 h Ambulatory Blood Pressure Monitoring, during the same day. Twenty-four hours Heart Rate variability analysis included: Time-domain, frequency-domain and non-linear domain. Results Mean age was 60 0a11.7 years, male gender was prevalent (68.4%). Among the population 26 (14.7%) subjects had diabetes; the prevalence of family history of CVD was 61.7% and 66.5% had dyslipidaemia; body mass index mean values were 27.6 7.4.3. In the whole population, the prevalence of uncontrolled AHT was 80.5%, divided into: 53.1% systo-diastolic, 17.9% isolated systolic, and 9.5% isolated diastolic. The prevalence of untreated AHT (recent diagnosis) was 40.2%, while treated AHT was 59.8% and only 19.6% had controlled blood pressure values (AHT at target). 12.3% of patients were treated with Beta Blockers. A significant correlations between diastolic blood pressure (DBP) values (24 h and day-time), LF/HF ratio (24 h) (r = 0.200; P = 007) and DFA alfa1 (24 h) (r = 0.325; P = 0.000), two know markers of sympathetic tone, were found. A higher sympathetic tone, expressed as high LF/HF, was found in isolated diastolic AHT compared to other types of AHT and the lowest sympathetic tone was found in isolated systolic AHT. Considering non-linear (complexity) analysis, DFA alfa1 (24 h) showed a significant correlation with DBP values that remained independent even after multiple adjustment for BMI, age, gender and Beta Blockers (β = 0.218; P = 0.011). Moreover, the lack of DBP control was associated with high sympathetic tone (LF/HF 3.8 112.3 vs 5.5 .33.3; P &lt; 0.0001). On the other hand, no significant correlations between all DBP data and vagal markers, such as SDNN index, RMSSD and HF, were found. Again, no significant correlations between 24 h, daytime, night-time SBP and time or frequency HRV data as well as with non-linear (complexity) analysis were found. Finally, considering ‘autonomic dipping’, expressed as changes in HRV data between day and night, a strong inverse correlation between vagal markers and Heart Rate Dipping (r = −0.297; P &lt; 0.0001) was found; correlation that remain independent even adjusted for age, gender, BMI, and BB. On the other hand, no association between blood pressure dipping and autonomic dipping was found. Conclusion Diastolic blood pressure and uncontrolled diastolic AHT, rather than systolic AHT, are associated with a hyper-sympathetic tone rather than with blunted vagal tone. The lack of heart rate dipping during night-time in AHT is associated with blunted vagal activation rather than a persistent night-time hyper-adrenergic tone.

Effect of anaesthetic and choice of neuromuscular blocker on vagal control of heart rate under laboratory animal experimental conditions

2017 ◽  
Vol 52 (3) ◽  
pp. 280-291
Author(s):  
Divya Sarma Kandukuri ◽  
Jacqueline K Phillips ◽  
Mark Tahmindjis ◽  
Cara M Hildreth
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Laboratory Animal ◽  
Baroreflex Sensitivity ◽  
Autonomic Function ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Isoflurane Anaesthesia ◽  
Blocking Agents

Neuromuscular-blocking agents are commonly used in laboratory animal research settings. Due to actions of cholinergic receptors at locations other than the motor end-plate, these agents have a strong propensity to modulate autonomic outflow and may therefore not be desirable in studies examining autonomic function. This study aimed to compare the effect of two non-depolarizing neuromuscular-blocking agents, pancuronium and cisatracurium, on blood pressure, heart rate and non-invasive indices of autonomic function (heart rate variability, systolic blood pressure variability and baroreflex sensitivity) under two different types of anaesthesia in Lewis rats. Pancuronium produced a profound vagolytic response characterized by tachycardia, reduction in heart rate variability and baroreflex sensitivity under urethane anaesthesia, and with minimal effect under isoflurane anaesthesia. Conversely, cisatracurium produced no evidence of vagolytic action under either urethane or isoflurane anaesthesia. Therefore, for studies interested in examining autonomic function, particularly baroreflex or vagal function, neuromuscular blockade would be best achieved using cisatracurium.

Advanced analysis of spontaneous baroreflex sensitivity, blood pressure and heart rate variability in patients with dilated cardiomyopathy

2002 ◽  
Vol 102 (4) ◽  
pp. 465-473 ◽  
Author(s):  
Hagen MALBERG ◽  
Niels WESSEL ◽  
Annett HASART ◽  
Karl-Josef OSTERZIEL ◽  
Andreas VOSS
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Systolic Blood Pressure ◽  
Dilated Cardiomyopathy ◽  
Healthy Subjects ◽  
Baroreflex Sensitivity ◽  
Left Ventricular ◽  
Sequence Method

Baroreflex sensitivity (BRS) is an important parameter in the classification of patients with reduced left ventricular function. This study aimed at investigating BRS in patients with dilated cardiomyopathy (DCM) and in healthy subjects (controls), as well as comparing the values of BRS parameters with parameters of heart rate variability (HRV) and blood pressure variability (BPV). ECG, continuous blood pressure and respiration curves were recorded for 30min in 27 DCM patients and 27 control subjects. The Dual Sequence Method (DSM) includes the analysis of spontaneous fluctuations in systolic blood pressure and the corresponding beat-to-beat intervals of heart rate to estimate bradycardic, opposite tachycardic and delayed baroreflex fluctuations. The number of systolic blood pressure/beat-to-beat interval fluctuations in DCM patients was reduced in comparison with controls (DCM patients: male, 154.4±93.9ms/mmHg; female, 93.7±40.5ms/mmHg; controls: male, 245.5±112.9ms/mmHg; female, 150.6±55.8ms/mmHg, P < 0.05). The average slope in DCM patients was lower than in controls (DCM, 5.3±1.9ms/mmHg; controls, 8.0±5.4ms/mmHg; P < 0.05). Discriminant function analysis showed that, in the synchronous range of the standard sequence method, the DCM and control groups could be discriminated to only 76% accuracy, whereas the DSM gave an improved accuracy of 84%. The combination of six parameters of HRV, BPV and DSM gives an accuracy of classification of 96%, whereas six parameters of HRV and BPV could separate the two groups to only 88% accuracy. Thus the DSM leads to an improved characterization of autonomous regulation in order to differentiate between DCM patients and healthy subjects. BRS in DCM patients is significantly reduced and apparently less effective.

scholarly journals Noninvasiveassessment of spontaneous baroreflex sensitivityin pregnancy

2008 ◽  
Vol 14 (1) ◽  
pp. 49-52
Author(s):  
F. Gugova ◽  
O. V. Mamontov ◽  
O. Bogomolova ◽  
E. Y. Petrenko ◽  
A. O. Konradi
Keyword(s):  
Blood Pressure ◽  
Early Pregnancy ◽  
Baroreflex Sensitivity ◽  
Autonomic Function ◽  
Late Pregnancy ◽  
Normal Pregnancy ◽  
Orthostatic Tolerance ◽  
Baroreflex Function ◽  
History Of ◽  
Spontaneous Baroreflex

The aim of the present study was to investigate evolution of autonomic function during normal pregnancy without history of hypertension. 23 women of mean age 27,4±4,4 yrs on 12-14 weeks of gestation were examined. Spontaneous baroreflex function (BRS) was analyzed by Finometer device with beat-to-beat blood pressure registration. All measurements were performed at supine rest and 5 minute passive tilt (70). Baroreflex was calculated by sequence technique. 12 women were studies second time on 26-30 week of pregnancy. A normal or increases values of spontaneous baroreflex were observed in early pregnancy with e significant reduction of baroreflex sensitivity during tilt. In late pregnancy restoration of the orthostatic tolerance was accompanied by decrease of BRS.

HEART COMPLICATIONS IN HYPERTHYROIDISM

2011 ◽  
pp. 7-17
Author(s):  
Hai Thuy Nguyen ◽  
Anh Vu Nguyen
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Heart Rate ◽  
Heart Diseases ◽  
Systolic Dysfunction ◽  
Oxygen Demand ◽  
Left Ventricular ◽  
Cardiac Contraction ◽  
Cardiac Complications ◽  
Cardiac Symptoms

Thyroid hormone increases the force of the contraction and the amount of the heart muscle oxygen demand. It also increases the heart rate. Due to these reasons, the work of the heart is greatly increased in hyperthyroidism. Hyperthyroidism increases the amount of nitric oxide in the intima, lead them to be dilated and become less stiff. Cardiac symptoms can be seen in anybody with hyperthyroidism, but can be particularly dangerous in whom have underlying heart diseases. Common symptoms include: tachycardia and palpitations. Occult hyperthyroidism is a common cause of an increased heart rate at rest and with mild exertion. Hyperthyroidism can also produce a host of other arrhythmias such as PVCs, ventricular tachycardia and especially atrial fibrillation. Left ventricular diastolic dysfunction and systolic dysfunction, Mitral regurgitation and mitral valve prolapsed are heart complications of hyperthyroism could be detected by echocardiography. The forceful cardiac contraction increases the systolic blood pressure despite the increased relaxation in the blood vessels reduces the diastolic blood pressure. Atrial fibrillation, atrial enlargement and congestive heart failure are important cardiac complications of hyperthyroidism. An increased risks of stroke is common in patients with atrial fibrillation. Graves disease is linked to autoimmune complications, such as cardiac valve involvement, pulmonary arterial hypertension and specific cardiomyopathy. Worsening angina: Patients with coronary artery disease often experience a marked worsening in symptoms with hyperthyroidism. These can include an increase in chest pain (angina) or even a heart attack.

Heart rate and blood pressure variability and baroreflex sensitivity in patients with acute brain injury

2005 ◽  
Vol 20 (4) ◽  
pp. 394 ◽  
Author(s):  
V. Papaioannou ◽  
M. Giannakou ◽  
N. Maglaveras ◽  
E. Sofianos ◽  
M. Giala
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Brain Injury ◽  
Blood Pressure Variability ◽  
Baroreflex Sensitivity ◽  
Acute Brain Injury
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