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Abbasi M, Ong KC, Newman DB, Dearani JA, Schaff HV, Geske JB. Obstruction in Hypertrophic Cardiomyopathy: Many Faces. J Am Soc Echocardiogr 2024; 37:613-625. [PMID: 38428652 DOI: 10.1016/j.echo.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/03/2024]
Abstract
Hypertrophic cardiomyopathy (HCM), the most common inherited cardiomyopathy, exhibits left ventricular hypertrophy not secondary to other causes, with varied phenotypic expression. Enhanced actin-myosin interaction underlies excessive myocardial contraction, frequently resulting in dynamic obstruction within the left ventricle. Left ventricular outflow tract obstruction, occurring at rest or with provocation in 75% of HCM patients, portends adverse prognosis, contributes to symptoms, and is frequently a therapeutic target. Transthoracic echocardiography plays a crucial role in the screening, initial diagnosis, management, and risk stratification of HCM. Herein, we explore echocardiographic evaluation of HCM, emphasizing Doppler assessment for obstruction. Echocardiography informs management strategies through noninvasive hemodynamic assessment, which is frequently obtained with various provocative maneuvers. Recognition of obstructive HCM phenotypes and associated anatomical abnormalities guides therapeutic decision-making. Doppler echocardiography allows monitoring of therapeutic responses, whether it be medical therapies (including cardiac myosin inhibitor therapy) or septal reduction therapies, including surgical myectomy and alcohol septal ablation. This article discusses the hemodynamics of obstruction and practical application of Doppler assessment in HCM. In addition, it provides a visual atlas of obstruction in HCM, including high-quality figures and complementary videos that illustrate the many facets of dynamic obstruction.
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Affiliation(s)
- Muhannad Abbasi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Kevin C Ong
- Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - D Brian Newman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey B Geske
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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Visby L, Møgelvang R, Grund FF, Myhr KA, Hassager C, Vejlstrup N, Mattu R, Kristensen CB. The Influence of Food Intake and Preload Augmentation on Cardiac Functional Parameters: A Study Using Both Cardiac Magnetic Resonance and Echocardiography. J Clin Med 2023; 12:6781. [PMID: 37959245 PMCID: PMC10648012 DOI: 10.3390/jcm12216781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: To investigate how food intake and preload augmentation affect the cardiac output (CO) and volumes of the left ventricle (LV) and right ventricle (RV) assessed using cardiac magnetic resonance (CMR) and trans-thoracic echocardiography (TTE). (2) Methods: Eighty-two subjects with (n = 40) and without (n = 42) cardiac disease were assessed using both CMR and TTE immediately before and after a fast infusion of 2 L isotonic saline. Half of the population had a meal during saline infusion (food/fluid), and the other half were kept fasting (fasting/fluid). We analyzed end-diastolic (EDV) and end-systolic (ESV) volumes and feature tracking (FT) using CMR, LV global longitudinal strain (GLS), and RV longitudinal strain (LS) using TTE. (3) Results: CO assessed using CMR increased significantly in both groups, and the increase was significantly higher in the food/fluid group: LV-CO (ΔLV-CO: +2.6 ± 1.3 vs. +0.7 ± 1.0 p < 0.001), followed by increased heart rate (HR) (ΔHR: +12 ± 8 vs. +1 ± 6 p < 0.001). LV and RV achieved increased stroke volume (SV) through different mechanisms. For the LV, through increased contractility, increased LV-EDV, decreased LV-ESV, increased LV-FT, and GLS were observed. For the RV, increased volumes, increased RV-EDV, increased RV-ESV, and at least for the fasting/fluid group, unchanged RV-FT and RV-LS were reported. (4) Conclusions: Preload augmentation and food intake have a significant impact on hemodynamic and cardiac functional parameters. This advocates for standardized recommendations regarding oral intake of fluid and food before cardiac assessment, for example, TTE, CMR, and right heart catheterization. We also demonstrate different approaches for the LV and RV to increase SV: for the LV by increased contractility, and for the RV by volume expansion.
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Affiliation(s)
- Lasse Visby
- Department of Cardiology, The Heart Center Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (F.F.G.)
| | - Rasmus Møgelvang
- Department of Cardiology, The Heart Center Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (F.F.G.)
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2100 Copenhagen, Denmark
- Cardiovascular Research Unit, University of Southern Denmark, Baagoees Allé 15, DK-5700 Svendborg, Denmark
| | - Frederik Fasth Grund
- Department of Cardiology, The Heart Center Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (F.F.G.)
| | - Katrine Aagaard Myhr
- Department of Cardiology, The Heart Center Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (F.F.G.)
| | - Christian Hassager
- Department of Cardiology, The Heart Center Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (F.F.G.)
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2100 Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Center Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (F.F.G.)
| | - Raj Mattu
- Kettering General Hospital NHS Foundation Trust, University Hospitals Northamptonshire, Kettering NN1 5BD, Northamptonshire, UK
- University College London, Gower St., London WC1E 6BT, UK
| | - Charlotte Burup Kristensen
- Department of Cardiology, The Heart Center Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (F.F.G.)
- Department of Cardiology, Lund University Hospital, Entrégatan 7, SE-22242 Lund, Sweden
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3
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Diaz-Canestro C, Sehgal A, Montero D. Acute regulation of erythropoietin via lower body negative pressure: Influence of sex and age. Scand J Med Sci Sports 2023; 33:535-541. [PMID: 36632690 DOI: 10.1111/sms.14314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/10/2022] [Accepted: 01/07/2023] [Indexed: 01/13/2023]
Abstract
The regulation of erythropoiesis via hemodynamic stimuli such as reduced central blood volume (CBV) remains uncertain in women and elderly individuals. This study assessed the acute effects of lower body negative pressure (LBNP) on key endocrine biomarkers regulating erythropoiesis, that is, erythropoietin (EPO) and copeptin, in young and older women and men (n = 87). Transthoracic echocardiography and hemodynamics were assessed throughout incremental LBNP levels for 1 hour, or until presyncope, with established methods. Venous blood samples were collected at baseline and immediately after termination of the orthostatic tolerance (OT) test for subsequent hormone analyses. The average age of young women and men (33.1 ± 6.0 vs. 29.5 ± 6.9 yr) and older women and men (63.8 ± 8.0 vs. 65.3 ± 8.9 yr) as well as their physical activity levels were matched within each age and sex group. CBV, as determined by right atrial volume, was reduced in all individuals at the end of the OT test (p < 0.001). The average OT time ranged from 50.1 to 58.1 min in all individuals. LBNP increased circulating EPO in young women (p = 0.023) but not in young men or older individuals. Copeptin was increased in all individuals with LBNP but was exclusively associated with EPO in men (r = 0.39, p = 0.013). The present study indicates that the acute hemodynamic regulation of EPO production is both sex- and age-dependent.
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Affiliation(s)
- Candela Diaz-Canestro
- Faculty of Medicine, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Arshia Sehgal
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - David Montero
- Faculty of Medicine, School of Public Health, Division of Kinesiology, University of Hong Kong, Hong Kong, Hong Kong SAR.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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4
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Gårdinger Y, Malmgren A, Hlebowicz J, Dencker M. Effect of food intake on echocardiographic measurements in healthy elderly. Echocardiography 2022; 39:811-818. [PMID: 35606943 DOI: 10.1111/echo.15368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This study evaluates whether food intake affects systolic and diastolic echocardiographic measurements in healthy seniors. METHODS Thirty healthy subjects 65-70 years of age were investigated with echocardiography, at fasting and then 30, 90, and 180 min after a meal. RESULTS After 30 min the biggest changes were seen in left ventricular wall stress and myocardial performance index with a decrease of 45% and 33%, respectively, compared to fasting values. Significant (p < .05) increases also were seen in left ventricular stroke volume, left ventricular cardiac output, left ventricular cardiac index, left ventricular outflow velocity-time integral, peak of early diastolic (E) and late diastolic (A) mitral flow velocities, the E/A ratio, pulsed tissue Doppler peak systolic (s') and early (e') and late (a') diastolic velocities, pulmonary vein peak velocities in systole (S) and diastole (D), mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), and global longitudinal strain (GLS) (increases ranging 6%-19%). After 90 min there remained a decrease in wall stress and myocardial performance index of 31% and 17%, respectively, and smaller, but still significant, changes could be seen in left ventricular stroke volume, left ventricular outflow velocity-time integral, MAPSE (lateral), TAPSE, GLS, and a few pulsed tissue Doppler peak systolic velocities and late diastolic velocities. An increase also could be seen in deceleration time of E-wave (DT). After 180 min, all variables except DT were back at baseline or below. No significant changes were seen in S/D ratio, lateral early diastolic velocity (e' lateral) and E/e'ratio. CONCLUSIONS This study shows that food intake affects commonly used echocardiographic parameters, both systolic and diastolic, in healthy seniors. With a few exceptions, the changes seen in the older population were less pronounced than previous studies in younger subjects.
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Affiliation(s)
- Ylva Gårdinger
- Department of Translational Medicine, Unit of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.,Department of Translational Medicine, Unit of Radiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Andreas Malmgren
- Department of Translational Medicine, Unit of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Joanna Hlebowicz
- Department of Clinical Sciences, Division of Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Magnus Dencker
- Department of Translational Medicine, Unit of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
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Kirla KT, Nemes S, Betts J, Kristensson C, Mo J, Asimus S, Sadiq MW, Redlich E, Koernicke T, Fuhr R, Brailsford W, Keen C, Hagberg A, Mäenpää J. Diurnal variation in DLCO and non-standardized study procedures may cause a false positive safety signal in clinical trials. Respir Med 2021; 191:106705. [PMID: 34879298 DOI: 10.1016/j.rmed.2021.106705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022]
Abstract
Diffusing capacity for carbon monoxide (DLCO) was measured in a phase I single ascending dose study after inhalation of AZD8154 or placebo in healthy participants at baseline (DLCOBaseline) and follow-up (DLCOFollow-up) 6 days after dosing. Initially, DLCOFollow-up timepoint was 2 h earlier than the DLCOBaseline timepoint and clinically significant decreases in DLCOFollow-up (absolute change up to 19% from baseline and DLCO%predicted values less than 70) were observed then. The observed reduction in DLCOFollow-up was confirmed as a false positive finding after alignment of DLCO timings. As a consequence, when DLCO is used in clinical studies, measurements should be strictly standardized in relation to time of the day.
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Affiliation(s)
- Krishna Tulasi Kirla
- Patient Safety, Respiratory & Immunology, Chief Medical Office, R&D, AstraZeneca, Gothenburg, Sweden
| | - Szilárd Nemes
- Early Biostats & Statistical Innovation, Data Science & AI, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Joanne Betts
- Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Cecilia Kristensson
- Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - John Mo
- Patient Safety, Respiratory & Immunology, Chief Medical Office, R&D, AstraZeneca, Gothenburg, Sweden
| | - Sara Asimus
- Clinical Pharmacology & Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Muhammad Waqas Sadiq
- Clinical Pharmacology & Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Gothenburg, Sweden
| | - Elke Redlich
- Parexel Early Phase Clinical Unit, Berlin, Germany
| | | | - Rainard Fuhr
- Parexel Early Phase Clinical Unit, Berlin, Germany
| | - Wayne Brailsford
- Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Christina Keen
- Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Anette Hagberg
- Patient Safety, Respiratory & Immunology, Chief Medical Office, R&D, AstraZeneca, Gothenburg, Sweden
| | - Jukka Mäenpää
- Patient Safety, Respiratory & Immunology, Chief Medical Office, R&D, AstraZeneca, Gothenburg, Sweden.
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6
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Possible effects of short rest after lunch on hemodynamics in the afternoon. Eur J Appl Physiol 2021; 122:523-530. [PMID: 34846579 DOI: 10.1007/s00421-021-04852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Drowsiness is often experienced in the afternoon after lunch. Decreases in blood flow to the brain secondary to increases in blood flow to the digestive organs after food intake could represent an underlying cause. As various beneficial effects of short rests on mental activities have been reported, the present study investigated hemodynamics using Doppler sonography of the common carotid artery (CCA) and superior mesenteric artery (SMA) after lunch, comparing resting and non-resting cases. METHODS Subjects comprised 24 healthy young adults (10 men, 14 women; mean age 22 ± 1 years). Sonography was performed to measure blood flow before and after lunch on each day, with and without a 15-min lying rest with eyes closed after lunch in each subject. RESULTS The timing of the peak velocity-time integral in the SMA in resting cases was delayed to 1.5 h after lunch compared to 0.5 h in non-resting cases. Although end-diastolic velocity in the CCA decreased after lunch, this decrease was suppressed in resting cases compared to non-resting cases even 4.5 h after lunch (median 96%, interquartile range [IQR] 83-102% vs. median 87%, IQR 77-92%; P = 0.037). Mean velocity (MV) in the CCA maintained unchanged after lunch in resting cases (P = 0.318), whereas non-resting cases showed decreased MV after lunch (P < 0.001). CONCLUSION These findings suggest that a short lying rest with eyes closed suppresses increases in blood flow to the digestive organ and maintains blood flow to the brain after lunch. These hemodynamic changes might help explain the benefits of afternoon rests.
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7
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Zreik F, Meshulam R, Shichel I, Webb M, Shibolet O, Jacob G. Effect of ingesting a meal and orthostasis on the regulation of splanchnic and systemic hemodynamics and the responsiveness of cardiovascular α 1-adrenoceptors. Am J Physiol Gastrointest Liver Physiol 2021; 321:G513-G526. [PMID: 34523347 DOI: 10.1152/ajpgi.00142.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Postprandial orthostasis activates mechanisms of cardiovascular homeostasis to maintain normal blood pressure (BP) and adequate blood flow to vital organs. The underlying mechanisms of cardiovascular homeostasis in postprandial orthostasis still require elucidation. Fourteen healthy volunteers were recruited to investigate the effect of an orthostatic challenge (60°-head-up-tilt for 20 min) on splanchnic and systemic hemodynamics before and after ingesting an 800-kcal composite meal. The splanchnic circulation was assessed by ultrasonography of the superior mesenteric and hepatic arteries and portal vein. Systemic hemodynamics were assessed noninvasively by continuous monitoring of BP, heart rate (HR), cardiac output (CO), and the pressor response to an intravenous infusion on increasing doses of phenylephrine, an α1-adrenoceptor agonist. Neurohumoral regulation was assessed by spectral analysis of HR and BP, plasma catecholamine and aldosterone levels and plasma renin activity. Postprandial mesenteric hyperemia was associated with an increase in CO, a decrease in SVR and cardiac vagal tone, and reduction in baroreflex sensitivity with no change in sympathetic tone. Arterial α1-adrenoceptor responsiveness was preserved and reduced in hepatic sinusoids. Postprandial orthostasis was associated with a shift of 500 mL of blood from mesenteric to systemic circulation with preserved sympathetic-mediated vasoconstriction. Meal ingestion provokes cardiovascular hyperdynamism, cardiac vagolysis, and resetting of the baroreflex without activation of the sympathetic nervous system. Meal ingestion also alters α1-adrenoceptor responsiveness in the hepatic sinusoids and participates in the redistribution of blood volume from the mesenteric to the systemic circulation to maintain a normal BP during orthostasis.NEW & NOTEWORTHY A unique integrated investigation on the effect of meal on neurohumoral mechanisms and blood flow redistribution of the mesenteric circulation during orthostasis was investigated. Food ingestion results in cardiovascular hyperdynamism, reduction in cardiac vagal tone, and baroreflex sensitivity and causes a decrease in α1-adrenoceptor responsiveness only in the venous intrahepatic sinusoids. About 500-mL blood shifts from the mesenteric to the systemic circulation during orthostasis. Accordingly, the orthostatic homeostatic mechanisms are better understood.
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Affiliation(s)
- Farid Zreik
- Department of Medicine, F and J. Recanati Autonomic Dysfunction Center, Tel Aviv "Sourasky" Medical Center, Tel Aviv, Israel
| | - Reshef Meshulam
- Department of Medicine, F and J. Recanati Autonomic Dysfunction Center, Tel Aviv "Sourasky" Medical Center, Tel Aviv, Israel
| | - Ido Shichel
- Department of Medicine, F and J. Recanati Autonomic Dysfunction Center, Tel Aviv "Sourasky" Medical Center, Tel Aviv, Israel
| | - Muriel Webb
- Department of Gastroenterology at Tel Aviv "Sourasky" Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Shibolet
- Department of Gastroenterology at Tel Aviv "Sourasky" Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giris Jacob
- Department of Medicine, F and J. Recanati Autonomic Dysfunction Center, Tel Aviv "Sourasky" Medical Center, Tel Aviv, Israel
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8
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La Canna G, Scarfò I, Arendar I, Alati E, Caso I, Alfieri O. Phenotyping Left Ventricular Obstruction With Postprandial Re-Test Echocardiography in Hypertrophic Cardiomyopathy. Am J Cardiol 2020; 125:1688-1693. [PMID: 32279840 DOI: 10.1016/j.amjcard.2020.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 02/07/2023]
Abstract
Dynamic left ventricular (LV) obstruction has important clinical and therapeutic implications in patients with hypertrophic cardiomyopathy (HC). Although absent at rest, LV obstruction may be elicited using varying stressors. Meal-related hemodynamic changes may favor LV obstruction and support postprandial (PP) symptoms in HC patients. The aim of this study was to evaluate PP-LV obstruction inducibility in HC patients in comparison with fasting Valsalva maneuver and exercise test. Ninety-two HC patients without LV obstruction underwent at-rest Transthoracic Echocardiography (TTE) during Valsalva maneuver and exercise test under fasting condition followed by at-rest re-test PP-TTE 30 to 60 minutes after a standardized midday meal. LV obstruction was noted and classified as being related to systolic anterior motion (SAM) of the mitral valve (SAM-related) and/or non-SAM-related (mid-cavity or apical), and intraventricular gradient was measured. At-rest re-test PP-TTE showed significant intraventricular gradient (>30 mm Hg) in 68 patients (60 SAM-related, 8 non-SAM related, 30 combined) with a higher prevalence (74%) of HC phenotype re-classified as obstructive compared with the fasting Valsalva maneuver (23%) or exercise test (33%) (p < 0.001). At multivariate analysis, a clinical history of PP symptoms and mitral anterior leaflet length and/or LV outflow ratio >2 were independently correlated with PP-TTE obstruction. In conclusion, PP TTE re-test is a simple and effective approach to unmask latent LV dynamic obstruction in daily clinical practice over fasting Valsalva maneuver or exercise test. PP clinical phenotype refinement may be relevant in targeting and evaluating HC therapy.
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Affiliation(s)
- Giovanni La Canna
- Applied Diagnostic Echocardiography Unit, Cardiovascular Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy.
| | - Iside Scarfò
- Applied Diagnostic Echocardiography Unit, Cardiovascular Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy
| | - Iryna Arendar
- Applied Diagnostic Echocardiography Unit, Cardiovascular Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy
| | - Emanuela Alati
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Ilaria Caso
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
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9
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Sarafian D, Charrière N, Maufrais C, Montani JP. Cardiovascular and Orthostatic Responses to a Festive Meal Associated With Alcohol in Young Men. Front Physiol 2019; 10:1183. [PMID: 31632281 PMCID: PMC6780004 DOI: 10.3389/fphys.2019.01183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/02/2019] [Indexed: 11/13/2022] Open
Abstract
Aim: Sharing a festive meal associated with alcohol is quite common. While the cardiovascular changes occurring after meal ingestion of different nutrient composition has been well-established, the effects of ingesting a festive versus a standard meal accompanied with alcohol are less clear. Here, we compared the postprandial hemodynamics, cutaneous and psychomotor performance responses after ingestion of a classical Swiss festive meal [cheese fondue (CF)] versus a light ready-meal [Nasi Goreng (NG)], both accompanied with white wine. Methods: In a randomized cross over design, we examined in 12 healthy young men, the continuous cardiovascular, cutaneous, and reaction time responses to ingestion of cheese fondue versus a standard meal at rest (sitting position) and hemodynamic changes in response to orthostatic challenge (active standing) in pre- and postprandial phases. Results: Breath alcohol concentration after wine ingestion was similar after both meal types. Compared to the standard meal, consumption of CF induced higher increases in heart rate (HR), cardiac output (CO), double product (DP) and cardiac power output (CPO), greater vasodilation, and rises in skin blood flow and skin temperature. Greater increases in HR, DP, and mean blood pressure (MBP) were observed during orthostatic challenges with CF compared to NG. A two-choice reaction time task revealed similar reaction times with both meals, suggesting no influence of meal composition on psychomotor performance. Conclusion: In sitting position, CF ingestion induced a more important cardiovascular load compared to NG. Although the dose of alcohol and the festive meal used here did not lead to orthostatic hypotension, eating CF induced a greater cardiometabolic load suggesting that hemodynamic reserves have been encroached during active standing. This may impede the cardiovascular capacity during physical exercise or stress situations, particularly in elderly subjects who are at greater risk for postprandial hypotension and cardiovascular diseases.
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Affiliation(s)
- Delphine Sarafian
- Laboratory of Integrative Cardiovascular and Metabolic Physiology, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Nathalie Charrière
- Laboratory of Integrative Cardiovascular and Metabolic Physiology, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Claire Maufrais
- Laboratory of Integrative Cardiovascular and Metabolic Physiology, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Jean-Pierre Montani
- Laboratory of Integrative Cardiovascular and Metabolic Physiology, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
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10
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Ishizeki A, Kishino T, Ogura S, Kuga H, Masai Y, Harashima K, Nakajima S, Otaki J, Ohnishi H, Watanabe T. Influence of breakfast on hemodynamics after lunch - a sonographic evaluation of mesenteric and cervical blood flows. Clin Physiol Funct Imaging 2018; 39:226-229. [PMID: 30515951 DOI: 10.1111/cpf.12556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
Abstract
Hemodynamics is subject to change after eating meals, which may be related to various postprandial physical statuses such as hypotension or daytime sleepiness. Previous studies have shown that blood flow in the superior mesenteric artery (SMA) increases after meals, but conflicting results have been reported regarding blood flow in the common carotid artery (CCA). In those studies, the fasting interval before the meal was not taken into account. For example, eating breakfast shortly before lunch may affect hemodynamics in these vessels. The present study therefore investigated hemodynamics in the CCA and SMA after lunch, comparing cases with and without breakfast. Subjects comprised 24 healthy young adults (mean age, 22 ± 1 years). Duplex Doppler sonography was performed to measure blood flow values for calculating flow volume (FV) before and after lunch until 3 h postprandially, on each day with breakfast and without breakfast, respectively, in every subject. Net FV after lunch did not differ between cases with and without breakfast, either in the SMA or in the CCA. Blood FV in the SMA was significantly increased after eating lunch regardless of whether breakfast was eaten (P<0·05 each). However, FV in the CCA was significantly decreased until 1 h after lunch compared with the preprandial state in cases without breakfast (P<0·05), but not in cases with breakfast. In conclusion, a sudden decrease in FV in the CCA from the preprandial state is seen after lunch when breakfast is skipped.
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Affiliation(s)
- Ayano Ishizeki
- Kyorin University Faculty of Health Sciences, Tokyo, Japan.,Kyorin University Hospital, Tokyo, Japan
| | - Tomonori Kishino
- Kyorin University Faculty of Health Sciences, Tokyo, Japan.,Kyorin University Hospital, Tokyo, Japan.,Kyorin University School of Medicine, Tokyo, Japan
| | - Sawano Ogura
- Kyorin University Faculty of Health Sciences, Tokyo, Japan.,Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Haruna Kuga
- Kyorin University Faculty of Health Sciences, Tokyo, Japan.,Saitama City Hospital, Saitama, Japan
| | - Yuki Masai
- Kyorin University Faculty of Health Sciences, Tokyo, Japan.,Meirikai Chuo General Hospital, Tokyo, Japan
| | | | | | - Junichi Otaki
- Kyorin University Faculty of Health Sciences, Tokyo, Japan
| | - Hiroaki Ohnishi
- Kyorin University Hospital, Tokyo, Japan.,Kyorin University School of Medicine, Tokyo, Japan
| | - Takashi Watanabe
- Kyorin University Hospital, Tokyo, Japan.,Kyorin University School of Medicine, Tokyo, Japan
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Murai S, Takase H, Sugiura T, Yamashita S, Ohte N, Dohi Y. Evaluation of the reduction in central and peripheral arterial blood pressure following an oral glucose load. Medicine (Baltimore) 2017; 96:e8318. [PMID: 29049241 PMCID: PMC5662407 DOI: 10.1097/md.0000000000008318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The clinical significance of measuring central arterial blood pressure has been recently discussed. Although the postprandial reduction in blood pressure is well known, postprandial changes in central blood pressure have not been intensively studied. The present study investigated differences in the reduction of central and peripheral arterial blood pressure after administration of an oral glucose load.An oral glucose tolerance test (75 g) was performed in 360 participants in our physical checkup program. Brachial and central systolic blood pressures were assessed before and after the glucose load. Central arterial blood pressure was measured noninvasively using an automated device.The mean age was 53.6 ± 8.2 years. Both brachial (127.9 ± 17.7 to 125.0 ± 16.3 mm Hg) and central arterial blood pressures were significantly decreased after an oral glucose load (118.9 ± 17.9 to 112.8 ± 16.8 mm Hg). The reduction in blood pressure was greater in central (7.3 ± 11.5 mm Hg) than in brachial blood pressure measurements (3.4 ± 11.3 mm Hg, P < .001). Extreme blood pressure reduction (>20 mm Hg) was recorded more frequently in central (n = 43, 12.3%) than brachial blood pressure measurements (n = 20, 5.6%).An oral glucose load decreases both central and brachial systolic blood pressure, with more pronounced effects on central blood pressure. Postprandial reductions in blood perfusion of the important organs such as the brain may be underestimated when postprandial BP reduction is assessed using brachial BP measurements.
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Affiliation(s)
- Shunsuke Murai
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | | | - Tomonori Sugiura
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - Sumiyo Yamashita
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - Yasuaki Dohi
- Department of Internal Medicine, Faculty of Rehabilitation Science, Nagoya Gakuin University, Nagoya, Japan
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Siervo M, Gan J, Fewtrell MS, Cortina-Borja M, Wells JCK. Acute effects of video-game playing versus television viewing on stress markers and food intake in overweight and obese young men: A randomised controlled trial. Appetite 2017; 120:100-108. [PMID: 28843974 DOI: 10.1016/j.appet.2017.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sedentary or near-sedentary activities are associated with overweight/obesity in epidemiological studies. This has traditionally been attributed to physical activity displacement. A little-explored area is whether behavioural stresses alter sensations of appetite and eating behaviour. We examined whether behaviours conducted seated (television viewing, video gaming) induce different eating patterns, associated with differential levels of stress response. METHODS AND FINDINGS We conducted a randomized controlled trial in 72 overweight/obese adult males, assigned to three groups (24 per group): (i) non-violent television (control group); (ii) non-violent game (FIFA); (iii) violent game (Call of Duty). Following a standardized breakfast, the 1-h intervention was followed by 25-min rest, with sweet and savoury snacks and drinks available ad libitum. Stress markers (heart rate, blood pressure, visual analogue scale (VAS)) were measured throughout. Heart rate, systolic blood pressure, and stress by VAS were significantly higher (p < 0.05) playing video games than watching non-violent television, though the two game groups did not differ. Considered separately, only the violent video game group consumed more energy (Δ = 208.3 kcal, 95%CI 16, 400), sweet foods (Δ = 25.9 g, 95%CI 9.9, 41.9) and saturated fat (Δ = 4.36 g, 95%CI 0.76, 7.96) than controls. CONCLUSION Playing video games in overweight/obese adult males is associated with an acute stress response relative to watching non-violent television, associated with greater subsequent food intake. These findings highlight the need to focus on the metabolic effects, as well as the energy costs, of activities involving sitting in relation to obesity risk.
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Affiliation(s)
- Mario Siervo
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne, NE4 5PL, UK.
| | - Jason Gan
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Mary S Fewtrell
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jonathan C K Wells
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne, NE4 5PL, UK; Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
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13
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Gårdinger Y, Dieden A, Hlebowicz J, Björgell O, Dencker M. Effect of food intake on myocardial performance index. Cardiovasc Ultrasound 2017; 15:10. [PMID: 28381254 PMCID: PMC5382399 DOI: 10.1186/s12947-017-0101-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/29/2017] [Indexed: 02/06/2023] Open
Abstract
Background Myocardial performance index (MPI) has been investigated in a variety of populations, but the effect of food intake has not been evaluated. We assessed whether myocardial performance index is affected by food intake in healthy subjects. Methods Twenty-three healthy subjects aged 25.6 ± 4.5 years were investigated. MPI was measured before, 30 min after, and 110 min after a standardized meal. Results MPI decreased significantly (P < 0.05) from fasting values 30 min after the meal, and had almost returned to baseline after 110 min. MPI decreased from 0.28 ± 0.06 (fasting) to 0.20 ± 0.07 30 min after eating. At 110 min after eating the index value was almost back to the baseline value 0.26 ± 0.06. (P = 0.15). Conclusions This study shows that myocardial performance index is affected by food intake in healthy subjects.
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Affiliation(s)
- Ylva Gårdinger
- Department of Translational medicine, Unit of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Malmö, Sweden. .,Department of Translational medicine, Unit of Radiology, Skåne University Hospital, Lund University, Malmö, Sweden.
| | - Anna Dieden
- Department of Translational medicine, Unit of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Joanna Hlebowicz
- Department of Clinical Sciences, Division of Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ola Björgell
- Department of Translational medicine, Unit of Radiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Magnus Dencker
- Department of Translational medicine, Unit of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
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14
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Bailey DG, Dresser GK, Urquhart BL, Freeman DJ, Arnold JM. Coffee-Antihypertensive Drug Interaction: A Hemodynamic and Pharmacokinetic Study With Felodipine. Am J Hypertens 2016; 29:1386-1393. [PMID: 27481881 DOI: 10.1093/ajh/hpw081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/12/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES A period of abstinence from coffee to permit caffeine elimination appears to enable increased blood pressure on subsequent exposure. We hypothesized that this would offset the antihypertensive effect of the dihydropyridine calcium channel blocker felodipine. METHODS A randomized, single-dose, crossover study assessed hemodynamic and pharmacokinetic effects following 2 days without coffee and caffeine-containing foods. Consistently brewed black coffee (2×300ml), felodipine maximum recommended dose (10mg), and coffee plus felodipine were tested in middle-aged normotensive subjects. RESULTS Pretreatment plasma caffeine concentrations were unquantifiable. After coffee, blood pressure changes (mm Hg) averaged over study hours 1-4 were increased for brachial systolic (7.6, P < 0.001) and diastolic (4.9, P < 0.001) and aortic systolic (7.4, P < 0.001), pulse (3.0, P < 0.05) and augmentation (1.4, P < 0.05) relative to baseline. After coffee plus felodipine, they were higher for brachial systolic (4.0, P < 0.05) and diastolic (3.9, P < 0.001) and aortic systolic (4.6, P < 0.05) compared to felodipine alone. The pressor effects of coffee and its modulation by felodipine were variable among individuals. Coffee containing caffeine (127mg) caused maximum pressor effect. Caffeine and felodipine pharmacokinetics were similar for coffee and felodipine given alone or in combination indicating an interaction having a pharmacodynamic basis. Plasma felodipine concentration-diastolic blood pressure reduction relationship shifted with coffee such that doubling the felodipine concentration would eliminate the pressor effect. However, this may increase the risk of adverse drug events particularly during the timeframe without coffee. CONCLUSION Intermittent coffee ingestion might complicate hypertension diagnosis and management for many individuals.
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Affiliation(s)
- David G Bailey
- Lawson Health Research Institute, London Health Sciences Centre, Western University, London, Ontario, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - George K Dresser
- Lawson Health Research Institute, London Health Sciences Centre, Western University, London, Ontario, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - David J Freeman
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - John Malcolm Arnold
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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15
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Kim TY, Kim MJ, Cho IR, Won YM, Han MK, Jung KN, Lee SH, Lee JH, Chin JH, Roh JH, Min SH, Lee TK, Park HJ, Jang K, Kwon SJ, Kang SJ, Shin MA, Kim HN, Hong JS, Choi EH, An NI, Kim JH, Kim MS. A study on macronutrient self-selection after acute aerobic exercise in college females. J Phys Ther Sci 2016; 28:2556-2559. [PMID: 27799693 PMCID: PMC5080175 DOI: 10.1589/jpts.28.2556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/26/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study was conducted to determine whether acute aerobic exercise (climbing)
is associated with changes in the dietary intake pattern. [Subjects and Methods] Food
intake and physical activity data for 15 female college students were sampled for 3 days
and categorized according to routine activity or high-intensity activity such as hiking.
Nutrient intake based on the data was analyzed using a nutrition program. [Results]
Carbohydrate and protein intake was significantly decreased after exercise compared to
before acute aerobic exercise, but lipid intake showed no significant difference. Calorie
intake was significantly decreased after exercise compared to before exercise; however,
calorie consumption was significantly increased after exercise. [Conclusion] Aerobic
exercise causes a decrease in total calories by inducing reduction in carbohydrate and
protein intake. Therefore, aerobic exercise is very important for weight (body fat)
control since it causes positive changes in the food intake pattern in female
students.
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Affiliation(s)
- Tae-Young Kim
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
| | - Min-Jeong Kim
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
| | - Ik-Rae Cho
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea; Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
| | - Yu-Mi Won
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
| | - Mi-Kyung Han
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
| | - Kon-Nym Jung
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
| | - Sang-Ho Lee
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
| | - Jae-Hee Lee
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
| | - Ji-Hyoung Chin
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
| | - Jae-Hun Roh
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
| | - Seung-Hi Min
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
| | - Taek-Kyun Lee
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
| | - Hyo-Joo Park
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
| | - Kwon Jang
- Department of Taekwondo, Korea National Sport University, Republic of Korea
| | - Se-Jeong Kwon
- Major of Recreation and Leisure Sports, College of Sports Science, Chung-Ang University, Republic of Korea
| | - Suh-Jung Kang
- Department of Exercise and Health Sciences, College of Natural Sciences, Sang Myung University, Republic of Korea
| | - Mi-Ae Shin
- College of Creative Future Talent, Daejin University, Republic of Korea
| | - Hu-Nyun Kim
- College of Creative Future Talent, Daejin University, Republic of Korea
| | - Jae-Seung Hong
- Department of Physical Education, College of Natural Sciences, Hallym University, Republic of Korea
| | - Eun-Hi Choi
- Department of Rehabilitation Medicine, College of Medicine, Hallym University, Republic of Korea
| | - Nam-Il An
- College of Humanities, Korea University, Republic of Korea
| | - Ji-Hyuk Kim
- Department of Dance Art, Convergence Culture and Arts, Sungshin Women's University, Republic of Korea
| | - Mi-Suk Kim
- Department of Dance Art, Convergence Culture and Arts, Sungshin Women's University, Republic of Korea
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16
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Niizeki K, Saitoh T. Analysis of cardiorespiratory phase coupling and cardiovascular autonomic responses during food ingestion. Physiol Behav 2016; 159:1-13. [PMID: 26969519 DOI: 10.1016/j.physbeh.2016.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/24/2016] [Accepted: 03/04/2016] [Indexed: 11/18/2022]
Abstract
The present study analyzed whether the phase coherency (λ) of respiratory sinus arrhythmia (RSA) is altered by food ingestion in healthy young subjects. After 5min of resting control, 13 healthy volunteers were asked to eat a solid meal with access to water at their own pace, followed by 5min of the postprandial state. The R-R interval (RRI), beat-to-beat blood pressure (BP), and respiratory activity were recorded using electrocardiography, a Finapres device, and inductance plethysmography, respectively. The stroke volume was calculated by the pulse-contour method from continuous BP measurement, and the cardiac output (CO) was obtained by multiplying the stroke volume by the heart rate. From the oscillatory signals of RSA and respiration, λ was computed; additionally, frequency domain indexes of the heart rate variability (HRV) were calculated using a short-time Fourier transform. A steady-state 3-min resting period (R), food ingestion period (FOOD), and the first 2-min and the last 3-min of the post prandial period were analyzed separately. We also compared the responses to gum chewing (GUM) and water intake (WATER) using the same protocol on separate days. A shortening of RRI and increases in BP and CO were observed in FOOD compared to R, suggesting a shift of sympathovagal balance toward sympathetic activation. Similar responses but smaller magnitudes were observed in the GUM condition, whereas only transient shortening of RRI was observed in the WATER condition. The HRV indexes did not show any significant changes in response to GUM and WATER but sympathovagal balance was shifted in favor of sympathetic dominance in FOOD. λ decreased during all of the conditions. There was a significant negative correlation between λ and the indirect measure of sympathovagal balance. These results suggest that ingestion of food induces enhanced cardiac sympathetic activity and that a phase coherence of RSA could provide a sensitive measure for evaluating the cardiac autonomic profile.
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Affiliation(s)
- Kyuichi Niizeki
- Department of Biosystems Engineering, Graduate School of Science and Engineering, Yamagata University, Japan.
| | - Tadashi Saitoh
- Department of Biosystems Engineering, Graduate School of Science and Engineering, Yamagata University, Japan
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17
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Campos I, Chan L, Zhang H, Deziel S, Vaughn C, Meyring-Wösten A, Kotanko P. Intradialytic Hypoxemia in Chronic Hemodialysis Patients. Blood Purif 2016; 41:177-87. [PMID: 26765143 DOI: 10.1159/000441271] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
When kidney failure occurs, patients are at risk for fluid overload states, which can cause pulmonary edema, pleural effusions, and upper airway obstruction. Kidney disease is also associated with impaired respiratory function, as in central sleep apnea or chronic obstructive pulmonary disease. Hence, respiratory and renal diseases are frequently coexisting. Hypoxemia is the terminal pathway of a multitude of respiratory pathologies. The measurement of oxygen saturation (SO2) is a basic and commonly used tool in clinical practice. Both arterial oxygen saturation (SaO2) and central venous oxygen saturation (ScvO2) can be easily obtained in hemodialysis (HD) patients, SaO2 from an arteriovenous access and ScvO2 from a central catheter. Here, we give a brief overview of the anatomy and physiology of the respiratory system, and the different technologies that are currently available to measure oxygen status in dialysis patients. We then focus on literature regarding intradialytic SaO2 and ScvO2. Lastly, we present clinical vignettes of intradialytic drops in SaO2 and ScvO2 in association with different symptoms and clinical scenarios with an emphasis on the pathophysiology of these cases. Given the fact that in the general population hypoxemia is associated with adverse outcomes, including increased mortality, cardiac arrhythmias and cardiovascular events, we posit that intradialytic SO2 may serve as a potential marker to identify HD patients at increased risk for morbidity and mortality.
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18
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Adams JC, Bois JP, Masaki M, Yuasa T, Oh JK, Ommen SR, Nishimura RA, Klarich KW. Postprandial Hemodynamics in Hypertrophic Cardiomyopathy. Echocardiography 2015; 32:1614-20. [DOI: 10.1111/echo.12951] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jonathon C. Adams
- Division of Cardiovascular Diseases; Mayo Clinic; Scottsdale Arizona
| | - John P. Bois
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Mitsuru Masaki
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Toshinori Yuasa
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Jae K. Oh
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Steve R. Ommen
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Rick A. Nishimura
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Kyle W. Klarich
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
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Dieden A, Gårdinger Y, Hlebowicz J, Björgell O, Dencker M. Effect of food intake on left and right ventricular systolic tissue Doppler measurements. Clin Physiol Funct Imaging 2015; 36:396-400. [PMID: 25976703 DOI: 10.1111/cpf.12242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 01/27/2015] [Indexed: 11/27/2022]
Abstract
Systolic tissue Doppler measurements (s') have been used to measure the velocity in myocardial motion and are a valuable tool for evaluating the systolic function of the left and right ventricles. Digestion of food is known to significantly alter hemodynamics and may therefore affect s'. The effect of food intake on s' parameters has not yet been studied. We assessed whether s' is affected by food intake. Nineteen healthy subjects aged 26·2 ± 4·2 years were investigated. s' was measured with pulsed tissue Doppler imaging in the right and left ventricles before the subjects ate a standardized meal and also 30 and 110 min after the meal. Three measurements were taken in each projection, and a mean value was calculated for each. s' increased significantly (P<0·05) from fasting to 30 min after food intake in every measured site except in the left inferolateral wall (P = 0·15, NS). Several, but not all, variables returned to base value 110 min after food intake. This study shows that food intake affects the tissue Doppler variables used to evaluate systolic heart function. Further studies are needed in older healthy subjects and older subjects with various cardiovascular diseases.
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Affiliation(s)
- Anna Dieden
- Department of Clinical Sciences, Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ylva Gårdinger
- Department of Clinical Sciences, Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Joanna Hlebowicz
- Division of Medicine, Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ola Björgell
- Department of Clinical Sciences, Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Magnus Dencker
- Department of Clinical Sciences, Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Malmö, Sweden
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20
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Naoum C, Puranik R, Falk GL, Yiannikas J, Kritharides L. Postprandial left atrial filling is impaired in patients with large hiatal hernia and improves following surgical repair. Int J Cardiol 2014; 182:291-3. [PMID: 25585365 DOI: 10.1016/j.ijcard.2014.12.133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 12/29/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Christopher Naoum
- Department of Cardiology, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, Hospital Road, Concord, NSW 2139, Australia
| | - Rajesh Puranik
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney Medical School, The University of Sydney, Sydney, Missenden Road, Camperdown, NSW 2050, Australia
| | - Gregory L Falk
- Department of Upper Gastrointestinal Surgery, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, Hospital Road, Concord, NSW 2139, Australia
| | - John Yiannikas
- Department of Cardiology, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, Hospital Road, Concord, NSW 2139, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, Hospital Road, Concord, NSW 2139, Australia.
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21
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Smits MM, Muskiet MHA, Tushuizen ME, Kwa KAA, Karemaker JM, van Raalte DH, Diamant M. Uncomplicated human type 2 diabetes is associated with meal-induced blood pressure lowering and cardiac output increase. Diabetes Res Clin Pract 2014; 106:617-26. [PMID: 25458327 DOI: 10.1016/j.diabres.2014.09.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 08/11/2014] [Accepted: 09/15/2014] [Indexed: 01/18/2023]
Abstract
AIMS Since many type 2 diabetes patients experience postprandial hypotension, the aim of this study was to unravel meal-related changes in systemic hemodynamics and autonomic nervous system (ANS)-balance. METHODS Forty-two age-matched males (15 type 2 diabetes; 12 metabolic syndrome; 15 controls) without overt autonomic neuropathy received a standardized high-fat mixed meal after an overnight fast. Hemodynamic variables were measured by finger plethysmography. Fourier analysis was used to calculate the low-/high-frequency (LF/HF)-ratio, a marker of autonomic nervous system-balance, and baroreceptor reflex sensitivity (BRS). RESULTS Following the meal, diastolic blood pressure (DBP) decreased in type 2 diabetes patients only, paralleled by a significant decrement in systemic vascular resistance (SVR) and an increase in cardiac index. All groups showed an increase in postprandial heart rate. Controls, but not metabolic syndrome or type 2 diabetes patients, showed a meal-related increase in LF/HF-ratio. When combining all study subjects, homeostatic model assessment-insulin resistance (HOMA-IR) was inversely correlated with changes in DBP, SVR, LF/HF-ratio and BRS. CONCLUSIONS Based on these data, we hypothesize that in patients with uncomplicated type 2 diabetes, insulin resistance hampers adequate meal-induced sympathetic activation, leading to a decrease in SVR and resulting in a postprandial drop in DBP.
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Affiliation(s)
- Mark M Smits
- Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | - Marcel H A Muskiet
- Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Maarten E Tushuizen
- Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Kelly A A Kwa
- Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - John M Karemaker
- Department of Systems Physiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Daniël H van Raalte
- Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Michaela Diamant
- Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
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22
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Okada M, Kakehashi M. Effects of outdoor temperature on changes in physiological variables before and after lunch in healthy women. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2014; 58:1973-81. [PMID: 24599494 PMCID: PMC4190455 DOI: 10.1007/s00484-014-0800-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 01/26/2014] [Accepted: 01/31/2014] [Indexed: 05/12/2023]
Abstract
Previous studies of autonomic nervous system responses before and after eating when controlling patient conditions and room temperature have provided inconsistent results. We hypothesized that several physiological parameters reflecting autonomic activity are affected by outdoor temperature before and after a meal. We measured the following physiological variables before and after a fixed meal in 53 healthy Japanese women: skin temperature, systolic and diastolic blood pressure, salivary amylase, blood glucose, heart rate, and heart rate variability. We assessed satiety before and after lunch using a visual analog scale (100 mm). We recorded outdoor temperature, atmospheric pressure, and relative humidity. Skin temperature rose significantly 1 h after eating (greater in cold weather) (P = 0.008). Cold weather markedly influenced changes in diastolic blood pressure before (P = 0.017) and after lunch (P = 0.013). Fasting salivary amylase activity increased significantly in cold weather but fell significantly after lunch (significantly greater in cold weather) (P = 0.007). Salivary amylase was significantly associated with cold weather, low atmospheric pressure, and low relative humidity 30 min after lunch (P < 0.05). Cold weather significantly influenced heart rate variability (P = 0.001). The decreased low frequency (LF)/high frequency (HF) ratio, increased Δ LF/HF ratio, and increased Δ salivary amylase activity imply that cold outdoor temperature is associated with dominant parasympathetic activity after lunch. Our results clarify the relationship between environmental factors, food intake, and autonomic system and physiological variables, which helps our understanding of homeostasis and metabolism.
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Affiliation(s)
- Masahiro Okada
- Department of Food and Dietetics, Hiroshima Bunka Gakuen Two-Year College, 3-5-1 Nagatsukanishi, Asaminami-ku, Hiroshima, 731-0136 Japan
| | - Masayuki Kakehashi
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
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Ussher JR, Baggio LL, Campbell JE, Mulvihill EE, Kim M, Kabir MG, Cao X, Baranek BM, Stoffers DA, Seeley RJ, Drucker DJ. Inactivation of the cardiomyocyte glucagon-like peptide-1 receptor (GLP-1R) unmasks cardiomyocyte-independent GLP-1R-mediated cardioprotection. Mol Metab 2014; 3:507-17. [PMID: 25061556 PMCID: PMC4099509 DOI: 10.1016/j.molmet.2014.04.009] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 04/27/2014] [Accepted: 04/28/2014] [Indexed: 01/07/2023] Open
Abstract
GLP-1R agonists improve outcomes in ischemic heart disease. Here we studied GLP-1R-dependent adaptive and cardioprotective responses to ventricular injury. Glp1r−/− hearts exhibited chamber-specific differences in gene expression, but normal mortality and left ventricular (LV) remodeling after myocardial infarction (MI) or experimental doxorubicin-induced cardiomyopathy. Selective disruption of the cardiomyocyte GLP-1R in Glp1rCM−/− mice produced no differences in survival or LV remodeling following LAD coronary artery occlusion. Unexpectedly, the GLP-1R agonist liraglutide still produced robust cardioprotection and increased survival in Glp1rCM−/− mice following LAD coronary artery occlusion. Although liraglutide increased heart rate (HR) in Glp1rCM−/− mice, basal HR was significantly lower in Glp1rCM−/− mice. Hence, endogenous cardiomyocyte GLP-1R activity is not required for adaptive responses to ischemic or cardiomyopathic injury, and is dispensable for GLP-1R agonist-induced cardioprotection or enhanced chronotropic activity. However the cardiomyocyte GLP-1R is essential for the control of HR in mice.
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Affiliation(s)
- John R Ussher
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Laurie L Baggio
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Jonathan E Campbell
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Erin E Mulvihill
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Minsuk Kim
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - M Golam Kabir
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Xiemin Cao
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Benjamin M Baranek
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Doris A Stoffers
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Randy J Seeley
- UC College of Medicine, University of Cincinnati, Cincinnati, USA
| | - Daniel J Drucker
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
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Gårdinger Y, Hlebowicz J, Björgell O, Dencker M. Effect of food intake on left ventricular wall stress. Cardiovasc Ultrasound 2014; 12:2. [PMID: 24468220 PMCID: PMC3922699 DOI: 10.1186/1476-7120-12-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 01/24/2014] [Indexed: 11/30/2022] Open
Abstract
Objective Left ventricular wall stress has been investigated in a variety of populations, but the effect of food intake has not been evaluated. We assessed whether left ventricular wall stress is affected by food intake in healthy subjects. Methods Twenty-three healthy subjects aged 25.6 ± 4.5 years were investigated. Meridional end-systolic wall stress (ESS) and circumferential end-systolic wall stress (cESS) were measured before, 30 minutes after, and 110 minutes after a standardised meal. Results Both ESS and cESS decreased significantly (P < 0.001) from fasting values 30 minutes after the meal, and had not returned to baseline after 110 minutes. ESS decreased from 65 ± 16 kdynes/cm2 (fasting) to 44 ± 12 kdynes/cm2 30 minutes after, and to 58 ± 13 kdynes/cm2 110 minutes after eating. cESS decreased from 98 ± 24 kdynes/cm2 to 67 ± 18 kdynes/cm2 30 minutes after, and to 87 ± 19 kdynes/cm2 110 minutes after the meal. Conclusion This study shows that left ventricular wall stress is affected by food intake in healthy subjects.
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Affiliation(s)
- Ylva Gårdinger
- Department of Clinical Sciences, Unit of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.
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Wakisaka S, Nagai H, Mura E, Matsumoto T, Moritani T, Nagai N. The effects of carbonated water upon gastric and cardiac activities and fullness in healthy young women. J Nutr Sci Vitaminol (Tokyo) 2013; 58:333-8. [PMID: 23327968 DOI: 10.3177/jnsv.58.333] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although previous reports suggested that carbonated water drinking was effective against gastrointestinal symptoms, there is little information about the effects of carbonated water on gastric and appetite sensation. We therefore investigated the effect of carbonated water on short-term fullness with respect to gastric and cardiac responses in 19 healthy young women. Each subject was tested on three separate days at approximately 9 a.m. after an overnight fast. Gastric motility, evaluated by electrogastrography (EGG) and heart rate (HR), was measured for 20 min in the fasting state and 40 min after ingestion of water. Preloads consisted of an equivalent amount (250 mL) of water (W) or carbonated water (CW) and no drinking (blank). Fullness scores were measured using visual analog scales. To determine gastric motility, we assessed the component of bradygastria (1-2 cycles/min [cpm]), normogastria (2-4 cpm), tachygastria (4-9 cpm), and dominant frequency of the EGG power spectrum. After ingestion of CW, significant increases in fullness scores were observed compared with W. All postprandial EGG powers were significantly greater than preprandial, but no group difference was found. However, a dominant frequency tended to shift toward a lower band after ingestion of W. A significantly higher HR was found following consumption of CW as opposed to W. Multiple regression analysis revealed that increased HR was a significant variable contributing to the variances in fullness after ingestion of CW at 40 min. Our data suggest that CW may induce a short-term, but significant, satiating effect through enhanced postprandial gastric and cardiac activities due possibly to the increased sympathetic activity and/or withdrawal of parasympathetic activity.
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Affiliation(s)
- Shiori Wakisaka
- Graduate School of Human Science and Environment, University of Hyogo, Himeji, Hyogo, Japan
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Yoshitani H, Takeuchi M, Otsuji Y, Akasaka T, Yoshida K. Possible further reduction in coronary flow velocity reserve in angina pectoris patients after oral glucose loading. J Echocardiogr 2013; 11:59-65. [PMID: 27278512 DOI: 10.1007/s12574-013-0164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 12/26/2012] [Accepted: 01/08/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies have suggested an increase in myocardial oxygen demand as a cause of postprandial angina. The purpose of this study was to assess coronary flow velocity reserve (CFVR) in the left anterior descending coronary artery (LAD) before and after glucose ingestion in patients with known significant LAD stenosis. METHODS Fourteen patients with significant LAD stenosis and 20 subjects without LAD stenosis were enrolled. Transthoracic Doppler echocardiography was performed to measure the average peak diastolic coronary flow velocity (APDV) in the LAD at rest and during adenosine infusion. CFVR was calculated as APDV during adenosine infusion (APDVATP) divided by APDV at rest (APDVrest). APDVrest, APDVATP, and CFVR were assessed during fasting and 30, 60, and 120 min after a 75-g oral glucose loading. RESULTS In patients with LAD stenosis, APDVrest at 30 min after glucose loading was the highest at any time point. However, significant differences were not found in the APDVATP among time points in the patients or controls. Consequently, the CFVR in the patients was the lowest at 30 min after glucose loading (fasting, 1.77 ± 0.19; 30 min, 1.48 ± 0.16; 60 min, 1.69 ± 0.17; and 120 min, 1.76 ± 0.19; p < 0.01, ANOVA), as in the controls. CONCLUSIONS These findings suggested that the value of CFVR in the LAD was reduced after glucose loading. Myocardial risk area supplied by a stenosed coronary artery may be exposed to myocardial ischemia more frequently during oral glucose loading than during fasting in patients with significant coronary artery stenosis.
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Affiliation(s)
- Hidetoshi Yoshitani
- The Second Department of Internal Medicine, University of the Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-0804, Japan.
| | - Masaaki Takeuchi
- The Second Department of Internal Medicine, University of the Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-0804, Japan
| | - Yutaka Otsuji
- The Second Department of Internal Medicine, University of the Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-0804, Japan
| | - Takashi Akasaka
- Department of Cardiology, Wakayama Medical University, Wakayama, Japan
| | - Kiyoshi Yoshida
- Department of Internal Medicine and Cardiology, Kawasaki Medical School, Kurashiki, Japan
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Hlebowicz J, Lindstedt S, Björgell O, Dencker M. The effect of endogenously released glucose, insulin, glucagon-like peptide 1, ghrelin on cardiac output, heart rate, stroke volume, and blood pressure. Cardiovasc Ultrasound 2011; 9:43. [PMID: 22206473 PMCID: PMC3280936 DOI: 10.1186/1476-7120-9-43] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 12/29/2011] [Indexed: 11/24/2022] Open
Abstract
Background Ingestion of a meal increases the blood flow to the gastrointestinal organs and affects the heart rate (HR), blood pressure and cardiac output (CO), although the mechanisms are not known. The aim of this study was to evaluate the effect of endogenously released glucose, insulin, glucagon-like peptide 1 (GLP-1), ghrelin on CO, HR, stroke volume (SV), and blood pressure. Methods Eleven healthy men and twelve healthy women ((mean ± SEM) aged: 26 ± 0.2 y; body mass index: 21.8 ± 0.1 kg/m2)) were included in this study. The CO, HR, SV, systolic and diastolic blood pressure, antral area, gastric emptying rate, and glucose, insulin, GLP-1 and ghrelin levels were measured. Results The CO and SV at 30 min were significantly higher, and the diastolic blood pressure was significantly lower, than the fasting in both men and women (P < 0.05). In men, significant correlations were found between GLP-1 level at 30 min and SV at 30 min (P = 0.015, r = 0.946), and between ghrelin levels and HR (P = 0.013, r = 0.951) at 110 min. Significant correlations were also found between the change in glucose level at 30 min and the change in systolic blood pressure (P = 0.021, r = -0.681), and the change in SV (P = 0.008, r = -0.748) relative to the fasting in men. The insulin 0-30 min AUC was significantly correlated to the CO 0-30 min AUC (P = 0.002, r = 0.814) in men. Significant correlations were also found between the 0-120 min ghrelin and HR AUCs (P = 0.007, r = 0.966) in men. No statistically significant correlations were seen in women. Conclusions Physiological changes in the levels of glucose, insulin, GLP-1 and ghrelin may influence the activity of the heart and the blood pressure. There may also be gender-related differences in the haemodynamic responses to postprandial changes in hormone levels. The results of this study show that subjects should not eat immediately prior to, or during, the evaluation of cardiovascular interventions as postprandial affects may affect the results, leading to erroneous interpretation of the cardiovascular effects of the primary intervention. Trial registration number NCT01027507
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Affiliation(s)
- Joanna Hlebowicz
- Center for Emergency, Department of Cardiology, Skåne University Hospital, Malmö, Lund University, Sweden.
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Dencker M, Björgell O, Hlebowicz J. Effect of food intake on commonly used pulsed Doppler and tissue Doppler measurements. Echocardiography 2011; 28:843-7. [PMID: 21827540 DOI: 10.1111/j.1540-8175.2011.01451.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study evaluates the effect of food intake on commonly used pulsed Doppler and tissue Doppler measurements. METHODS Twenty-three healthy subjects aged 25.6 ± 4.5 years were investigated. A wide selection of pulsed Doppler and tissue Doppler variables were measured before a standardized meal as well as and 30 and 110 minutes afterwards. RESULTS The following variables increased significantly (P < 0.05) 30 minutes after food intake: left ventricular stroke volume, left ventricular cardiac output, left ventricular outflow velocity-time integral, peak of early diastolic (E) and late diastolic (A) mitral flow velocities, pulmonary vein peak velocities in systole (S) and in diastole (D), S/D, pulsed tissue Doppler peak systolic velocities, and late diastolic velocities. Deceleration time of E-wave decreased significantly (P < 0.05). The change in measured variables between fasting and 30 minutes after the food intake ranged from 7% to 28%. There were no significant (P > 0.05) changes in E/A, early diastolic tissue Doppler velocities (e'), and E/e'. Most, but not all variables returned to baseline values 110 minutes after food intake. CONCLUSIONS This study shows that food intake affects several echocardiographic variables used to routinely assess diastolic function and hemodynamics. Further studies are warranted in older healthy subjects and in patients with various cardiac diseases to determine whether the findings are reproducible in such populations.
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Affiliation(s)
- Magnus Dencker
- Department of Clinical Physiology and Nuclear Medicine, Lund University, Skåne University Hospital, Malmö, Sweden.
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Hlebowicz J, Lindstedt S, Björgell O, Dencker M. Relationship between postprandial changes in cardiac left ventricular function, glucose and insulin concentrations, gastric emptying, and satiety in healthy subjects. Nutr J 2011; 10:26. [PMID: 21429209 PMCID: PMC3075212 DOI: 10.1186/1475-2891-10-26] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 03/23/2011] [Indexed: 11/12/2022] Open
Abstract
Background The digestion of food is known to alter the hemodynamics of the body significantly. The purpose of this study was to study the postprandial changes in stroke volume (SV), cardiac output (CO) and left ventricular (LV) longitudinal systolic and diastolic functions measured with tissue Doppler imaging, in relation to gastric emptying rate (GER), satiety, and glucose and insulin concentrations in healthy subjects. Methods Twenty-three healthy subjects were included in this study. The fasting and postprandial changes at 30 min and 110 min in CO, heart rate (HR) and blood pressure were measured. Moreover, tissue Doppler imaging systolic (S'), early (E') and late (A') mitral annular diastolic velocities were measured in the septal (s) and lateral (l) walls. Glucose and insulin concentrations, and satiety were measured before and 15, 30, 45, 60, 90, and 120 min after the start of the meal. The GER was calculated as the percentage change in the antral cross-sectional area 15-90 min after ingestion of the meal. Results This study show that both CO, systolic longitudinal ventricular velocity of the septum (S's) and lateral wall (S'l), the early diastolic longitudinal ventricular velocity of the lateral wall (E'l), the late diastolic longitudinal ventricular velocity of the septum (A's) and lateral wall (A'l) increase significantly, and were concomitant with increased satiety, antral area, glucose and insulin levels. The CO, HR and SV at 30 min were significantly higher, and the diastolic blood pressure was significantly lower, than the fasting. The satiety was correlated to HR and diastolic blood pressure. The insulin level was correlated to HR. Conclusions This study shows that postprandial CO, HR, SV and LV longitudinal systolic and diastolic functions increase concomitantly with increased satiety, antral area, and glucose and insulin levels. Therefore, patients should not eat prior to, or during, cardiac evaluation as the effects of a meal may affect the results and their interpretation. Trial Registration ClinicalTrials.gov: NCT01027507
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Affiliation(s)
- Joanna Hlebowicz
- Department of Medicine/Cardiology, Lund University, Skåne University Hospital, Malmö, Sweden.
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30
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Kansal MM, Mookadam F, Tajik AJ. Drink more, and eat less: advice in obstructive hypertrophic cardiomyopathy. Am J Cardiol 2010; 106:1313-6. [PMID: 21029830 DOI: 10.1016/j.amjcard.2010.06.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 06/28/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
Abstract
This report describes a series of symptomatic patients with obstructive hypertrophic cardiomyopathy with significant postprandial hemodynamic changes. This finding was identified by history, clinical examination, and echocardiography in 6 consecutive symptomatic patients referred for the evaluation of ventricular septal reduction therapy. Counseling these patients with dietary changes to include small frequent meals and to increase noncaffeinated fluid intake resulted in reductions in symptoms. In conclusion, severe symptoms in obstructive hypertrophic cardiomyopathy unresponsive to pharmacologic treatment frequently result in referral for definitive septal reduction therapy through surgery or, less frequently, alcohol septal ablation therapy. However, recognition of postprandial exacerbation in symptomatic patients may allow for nonpharmacologic dietary interventions that may obviate the need for more invasive therapies and their associated complications.
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Adams JC, Ommen SR, Klarich KW, Tajik AJ, Nishimura RA. Significance of postprandial symptom exacerbation in hypertrophic cardiomyopathy. Am J Cardiol 2010; 105:990-2. [PMID: 20346318 DOI: 10.1016/j.amjcard.2009.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 11/13/2009] [Accepted: 11/13/2009] [Indexed: 11/26/2022]
Abstract
Patients with hypertrophic cardiomyopathy (HC) can experience exacerbation of exertional symptoms after a meal. The present study was designed to determine the prevalence and clinical correlates of postprandial symptom exacerbation (PPSE) in patients with HC. The records of 558 patients with HC and PPSE data who had undergone echocardiography at our institution from 2002 to 2006 were reviewed. Continuous-wave Doppler velocities were used to determine the left ventricular outflow tract gradient. Left ventricular filling was assessed using transmitral velocity curves. The Minnesota Living With Heart Failure questionnaire was administered to measure symptom limitations. A multivariate regression model was developed to determine the independent correlates with PPSE. Of the 558 patients whose records were reviewed, 189 (33.8%) had PPSE. The patients with PPSE were more likely to experience New York Heart Association class III/IV dyspnea or presyncope. PPSE was associated with greater resting outflow gradients and lower perceived quality of life. In conclusion, patients presenting with severe postprandial symptoms and reduced quality of life should be carefully evaluated for the presence of dynamic left ventricular outflow tract obstruction.
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van der Meer RW, Hammer S, Lamb HJ, Frölich M, Diamant M, Rijzewijk LJ, de Roos A, Romijn JA, Smit JWA. Effects of short-term high-fat, high-energy diet on hepatic and myocardial triglyceride content in healthy men. J Clin Endocrinol Metab 2008; 93:2702-8. [PMID: 18430773 DOI: 10.1210/jc.2007-2524] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT An association has been suggested between elevated plasma nonesterified fatty acid (NEFA) levels, myocardial triglyceride (TG) accumulation, and myocardial function. OBJECTIVE Our objective was to investigate the effects of an elevation of plasma NEFA by a high-fat, high-energy (HFHE) diet on hepatic and myocardial TG accumulation, and on myocardial function. DESIGN There were 15 healthy males (mean +/- sd age: 25.0 +/- 6.6 yr) subjected to a 3-d HFHE diet consisting of their regular diet, supplemented with 800 ml cream (280 g fat) every day. METHODS (1)H-magnetic resonance spectroscopy was performed for assessing hepatic and myocardial TGs. Furthermore, left ventricular function was assessed using magnetic resonance imaging. RESULTS The HFHE diet increased hepatic TGs compared with baseline (from 2.01 +/- 1.79 to 4.26 +/- 2.78%; P = 0.001) in parallel to plasma TGs and NEFA. Myocardial TGs did not change (0.38 +/- 0.18 vs. 0.40 +/- 0.12%; P = 0.7). The HFHE diet did not change myocardial systolic function. Diastolic function, assessed by dividing the maximum flow across the mitral valve of the early diastolic filling phase by the maximum flow of the atrial contraction (E/A ratio), decreased compared with baseline (from 2.11 +/- 0.39 to 1.89 +/- 0.33; P = 0.031). This difference was no longer significant after adjustment for heart rate (P = 0.12). CONCLUSIONS Short-term HFHE diet in healthy males results in major increases in plasma TG and NEFA concentrations and hepatic TGs, whereas it does not influence myocardial TGs or myocardial function. These observations indicate differential, tissue-specific partitioning of TGs and/or fatty acids among nonadipose organs during HFHE diet.
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Sivalingam M, Banerjee A, Nevett G, Farrington K. Haemodynamic Effects of Food Intake during Haemodialysis. Blood Purif 2008; 26:157-62. [DOI: 10.1159/000114094] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 10/19/2007] [Indexed: 11/19/2022]
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Yokogawa M, Ueda K, Murase J, Miaki H, Sasaki M, Inoue K, Susaki T, Tachino K. Effects of Food Intake on Physiological Responses to Cardiopulmonary Exercise Testing. J Phys Ther Sci 2007. [DOI: 10.1589/jpts.19.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Masami Yokogawa
- Division of Rehabilitation Science, Department of Health Sciences, Graduate School for Health Studies, The University of Kanazawa
| | | | - Junji Murase
- Department of Medical Rehabilitation Services, Kariya Toyota General Hospital
| | - Hiroichi Miaki
- Division of Rehabilitation Science, Department of Health Sciences, Graduate School for Health Studies, The University of Kanazawa
| | - Makoto Sasaki
- Department of Physical Therapy, School of Health Sciences, Akita University
| | - Katsumi Inoue
- Division of Rehabilitation Science, Department of Health Sciences, Graduate School for Health Studies, The University of Kanazawa
| | - Toshio Susaki
- Division of Rehabilitation Science, Department of Health Sciences, Graduate School for Health Studies, The University of Kanazawa
| | - Katsuhiko Tachino
- Division of Rehabilitation Science, Department of Health Sciences, Graduate School for Health Studies, The University of Kanazawa
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Pivik RT, Dykman RA, Tennal K, Gu Y. Skipping breakfast: gender effects on resting heart rate measures in preadolescents. Physiol Behav 2006; 89:270-80. [PMID: 16843505 DOI: 10.1016/j.physbeh.2006.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Revised: 04/12/2006] [Accepted: 06/08/2006] [Indexed: 11/29/2022]
Abstract
The cardiovascular response in children to morning nutrition has received little attention, and associated gender-related effects are virtually uninvestigated. This study evaluated resting heart-rate (HR) and heart-rate variability (HRV) in preadolescents after overnight fasting and again after eating a standardized breakfast or continuing to fast. HR increased slightly after eating and decreased significantly with continued fasting. These effects were present for both sexes. Relative to children who ate, those who continued fasting showed increases in HRV-particularly for inter-beat-interval and low frequency component (LF: 0.04-0.15 Hz) measures. Analyses revealed significant increases across variability measures for fasting children, but a selective LF decrease in those who were fed-an effect most prominent in females. Otherwise, males and females showed similar treatment-related changes in HRV. While within-gender comparisons showed similar results for HR, i.e., faster HR in fed compared with fasting males and females, respectively, fasting females-but not males-showed significantly greater increases in variability relative to their fed counterparts. Together, these findings suggest that extended overnight fasting initiates an increase in parasympathetic activity that attenuates the expected increase in cardiovascular output following a mid-morning meal. Observed gender differences were related to greater parasympathetic activity in males and to the apparent emphasis on parasympathetic regulation of LF variability. The implications of these findings for health concerns, the nature of responses to physiological and cognitive stressors, and how such differences may influence performance variables-particularly early in development when cardiovascular responses to these stressors may be more sensitive to nutritional factors-are discussed.
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Affiliation(s)
- R T Pivik
- Brain Function Laboratory, Arkansas Children's Nutrition Center, United States.
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Abstract
Orthostatic hypotension is a common condition among nursing home (NH) residents. NH residents tend to have multiple disease processes and tend to be on multiple medications associated with orthostatic hypotension and are predisposed to a myriad of negative clinical consequences, most notably falls. This article discusses a commonsense approach to diagnosis, evaluation, and treatment of patients with this disorder, with an emphasis on nonpharmacological interventions, such as patient and staff education.
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Affiliation(s)
- Lukasz Iwanczyk
- UCLA Multicampus Geriatrics Fellowship Program, Sepulveda, CA 91343, USA.
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Fisher AA, Davis MW, Le Couteur DG. The effect of meals at different mealtimes on blood pressure and symptoms in geriatric patients with postprandial hypotension. J Gerontol A Biol Sci Med Sci 2005; 60:184-5; author reply 185-6. [PMID: 15814859 DOI: 10.1093/gerona/60.2.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sorrentino P, Tarantino G, Conca P, Ragucci P, Perrella A. Abnormally high resistive index of central retinal artery by ultrasound color Doppler in patients with viral chronic liver disease: correlation with worsening liver staging. ULTRASOUND IN MEDICINE & BIOLOGY 2004; 30:599-604. [PMID: 15183224 DOI: 10.1016/j.ultrasmedbio.2004.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Revised: 02/17/2004] [Accepted: 02/26/2004] [Indexed: 02/08/2023]
Abstract
Retrobulbar-ocular circulation provides an opportunity to assess the terminal circulation of the arterial cerebral tree. To evaluate whether retrobulbar circulation in patients with chronic liver disease is affected by adaptive mechanisms, we assessed by echo color Doppler, 1. The resistive-index of the central retinal artery, a terminal branch of the ophthalmic artery, and 2. the potential interrelationships with both liver staging and the most important splanchnic Doppler-parameters used to assess portal hypertension. The resistance index (RI) of the central retinal artery was obtained and compared with other classical Doppler parameters known to be affected by portal hypertension. The RI of the central retinal artery (CRA) was higher in cirrhotic patients than in controls or subjects with chronic hepatitis; it correlated with all the Doppler parameters of portal hypertension considered, with plasma renin-activity, and norepinephrine concentrations. Similarly to renal and splanchnic hemodynamics, retinal arterial circulation assessed by duplex Doppler seems to be affected by the histology of liver disease and by the overactivity of vasoconstrictor systems.
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Affiliation(s)
- Paolo Sorrentino
- Department of Clinical and Experimental Medicine, Federico II University Medical School, Naples, Italy
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Marthol H, Tutaj M, Brys M, Brown CM, Hecht MJ, Berlin D, Axelrod FB, Hilz MJ. Clonidine improves postprandial baroreflex control in familial dysautonomia. Eur J Clin Invest 2003; 33:912-8. [PMID: 14511364 DOI: 10.1046/j.1365-2362.2003.01242.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with familial dysautonomia (FD) frequently experience hypertensive crises after gastrostomy feeding. The central alpha2-agonist clonidine attenuates feeding-induced crises. The aim of this study was to assess the effect of clonidine on cardiovascular autonomic modulation and particularly baroreflex sensitivity in familial dysautonomia after gastrostomy feeding. MATERIAL AND METHODS In nine patients, we monitored the RR-interval and systolic blood pressure at supine rest before (baseline 1) and after gastrostomy feeding (GF1). One day later, recordings were repeated after clonidine intake (baseline 2, GF2). We determined spectral powers of RR-interval and systolic blood pressure in the low- (LF) and high-frequency range (HF). Sympathovagal balance was determined from the LF/HF ratio of RR-interval. Baroreflex sensitivity was assessed from the alpha-index of systolic blood pressure and RR-interval. RESULTS Gastrostomy feeding decreased RR-interval, while systolic blood pressure remained stable. Clonidine induced higher RR-intervals before and after gastrostomy feeding but decreased systolic blood pressure at baseline only. Gastrostomy feeding decreased HF-power of RR-interval significantly without clonidine, but only slightly after premedication. Clonidine increased the HF-power of RR-interval slightly at baseline and significantly after gastrostomy feeding. Gastrostomy feeding increased the LF/HF ratio without clonidine only. Clonidine decreased the LF/HF ratio at baseline and after gastrostomy feeding. Gastrostomy feeding did not change baroreflex sensitivity, but baroreflex sensitivity was higher at visit 2 than visit 1. CONCLUSIONS In familial dysautonomia, clonidine augments baroreflex sensitivity and parasympathetic modulation. The resulting cardiovascular stabilization might attenuate feeding-induced crises.
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Affiliation(s)
- H Marthol
- Department of Neurology, New York University School of Medicine, New York, NY, USA
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Fagius J. Sympathetic nerve activity in metabolic control--some basic concepts. ACTA PHYSIOLOGICA SCANDINAVICA 2003; 177:337-43. [PMID: 12609004 DOI: 10.1046/j.1365-201x.2003.01086.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A role for the sympathetic nervous system in hypertension has been looked for in relation to the 'metabolic syndrome' with associations between body weight, insulin sensitivity and hypertension. By use of microneurography human sympathetic responses to hypoglycaemia, normoglycaemic hyperinsulinaemia and food intake have been studied. A strong but differentiated influence of insulin-induced hypoglycaemia comprises increase in muscle sympathetic nerve activity (MSNA) and the sudomotor part of skin sympathetic nerve activity (SSNA), whereas vasoconstrictor SSNA is inhibited. Responses to infusion of 2-deoxy-D-glucose are identical, suggesting central nervous system glucopenia and not insulin to be the causative factor. Insulin infusion during normoglycaemia evokes a moderate increase in MSNA; SSNA and blood pressure does not change. After glucose ingestion MSNA displays a sustained increase, which is only partly elicited by insulin. A significant albeit weaker increase occurs after pure protein or fat meals, and after glucose ingestion in C-peptide-negative diabetic patients, with no insulin secretion. In healthy elderly people the MSNA response to food intake is weak, because of a high outflow already at rest; this is suggested to explain postprandial hypotension in the elderly, a paradoxical mechanism behind clinical autonomic failure. A pathophysiological role of MSNA in the metabolic syndrome with hypertension has been speculated. An association between obesity and elevated level of MSNA at rest is established; observed relationships to chronic insulin levels and hypertension are less unanimous. The adipose tissue regulating hormone leptin has become one focus of interest in ongoing attempts to elucidate a possible role of the human sympathetic nervous system in the 'metabolic syndrome' and hypertension.
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Affiliation(s)
- J Fagius
- Department of Neurology, University Hospital, Uppsala, Sweden
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Chung WY, Sohn DW, Kim YJ, Oh S, Chai IH, Park YB, Choi YS. Absence of postprandial surge in coronary blood flow distal to significant stenosis: a possible mechanism of postprandial angina. J Am Coll Cardiol 2002; 40:1976-83. [PMID: 12475458 DOI: 10.1016/s0735-1097(02)02533-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study was designed to investigate a possible mechanism of postprandial angina. BACKGROUND Postprandial angina has been recognized for more than two centuries; however, its mechanism is still controversial. The most widely accepted mechanism involves increased myocardial oxygen demand after food intake. Recently, the redistribution in coronary blood flow (CBF) was suggested as a possible mechanism. METHODS Twenty young, healthy volunteer controls and 20 patients with significant stenosis in the left anterior descending (LAD) or left main coronary artery were enrolled in the study. Coronary blood flow was evaluated in the distal LAD by using transthoracic Doppler echocardiography before and 15, 30, 45, and 60 min after food intake. In the CBF curve, the time velocity integral of diastolic flow (Dtvi) and the product of Dtvi and heart rate (HR) were measured. In six patients, these measurements were repeated after successful coronary intervention. RESULTS In the healthy volunteer controls, Dtvi and Dtvi x HR increased after food intake with a peak value at 15 min, which indicates the presence of postprandial surge in the CBF. Fasting values and peak values at 15 min were significantly different (Dtvi: 15.1 +/- 4.9 cm/s vs. 18.9 +/- 5.9 cm/s, p = 0.04, Dtvi x HR: 862.2 +/- 261.5 cm/min vs. 1,174.2 +/- 307.5, p = 0.002). In contrast with the controls, despite postprandial increase in double product (HR x blood pressure), Dtvi and Dtvi x HR in the patient group decreased after food intake, with a nadir value at 45 min. Fasting values and nadir values at 45 min were significantly different (Dtvi: 24.0 +/- 19.6 cm/s vs. 19.3 +/- 17.1 cm/s, p < 0.001, Dtvi x HR: 1,449.6 +/- 1,044.0 cm/min vs. 1,273.4 +/- 1,000.9 cm/min, p = 0.002). In six patients, the CBF pattern resumed the normal pattern of postprandial surge in the CBF after successful coronary intervention. CONCLUSIONS Results of our study suggest that "steal phenomenon" may play a role in the mechanism of postprandial angina.
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Affiliation(s)
- Woo-Young Chung
- Clinical Research Institute and Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Abstract
Postprandial hypotension is a prevalent condition in the elderly population and seems to be more common in frail elderly individuals who may be more susceptible to complications such as syncope and falls. Diagnosis is relatively easy and may be reversible in many cases. The epidemiology and pathophysiology of postprandial hypotension are not defined fully; however, a number of pathologic processes likely are involved, including abnormal sympathetic function, baroreceptor function, and vasoactive peptide release and activity. The precise relationship between symptoms and postprandial reductions in blood pressure is unclear. Blood pressure maintenance after a meal may depend on the interaction of some or all of the mechanisms outlined previously to compensate for the increase in bowel blood volume. The impairment of one or more of these mechanisms could result in inadequate compensation that leads to hypotension. If so, the presence of symptoms depends on that individual patient's ability to exercise adequate compensatory cerebral autoregulation. A hypertensive elderly patient may experience symptoms with only a small reduction in blood pressure, whereas a patient with autonomic failure may require a much larger fall in blood pressure to occur before they become symptomatic. The current definition of postprandial hypotension uses a threshold of 20 mm Hg as a cut off for diagnosis, but this may not be relevant to the presence or absence of symptoms. Further epidemiologic data are needed. Additionally, there is a lack of controlled trial evidence for the drugs that are used to treat this condition, and treatment often is carried out on a trial-and-error basis. Further research must be performed to identify the specific pathophysiology in certain patient groups, such as elderly hypertensive patients and those with autonomic failure, and to identify effective pharmacologic therapies that can be supported by randomized, placebo-controlled trials.
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Affiliation(s)
- Gerard O'Mara
- Department of Medical Gerontology, Mid Western Regional Hospital, University of Limerick, Dooradoyle, Limerick, Ireland
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Vorobioff JD, Gamen M, Kravetz D, Picabea E, Villavicencio R, Bordato J, Ruf A, Bessone F, Romero G, Palazzi J, Nicora A, Passamonti M, Tanno H. Effects of long-term propranolol and octreotide on postprandial hemodynamics in cirrhosis: a randomized, controlled trial. Gastroenterology 2002; 122:916-22. [PMID: 11910343 DOI: 10.1053/gast.2002.32395] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND & AIMS Postprandial increases in portal pressure may influence esophageal variceal rupture. The effects of chronic propranolol and octreotide (100 and 200 microg subcutaneously in a single dose) on postprandial hemodynamics were evaluated. METHODS FIRST STUDY: 36 cirrhotic patients were studied at baseline and 30 and 60 minutes after a standard meal and then treated with propranolol (139 +/- 9 mg/d during 39 +/- 2 days). SECOND STUDY: After baseline measurements, patients were randomized into 3 groups: (1) placebo, (2) octreotide (100 microg), or (3) octreotide (200 microg) (n = 12 for each group). Thirty minutes postinjection a new baseline was established and measurements were repeated 30 and 60 minutes after the meal. RESULTS First study: Baseline portal pressure was 18.1 +/- 1.2 mm Hg, 30 and 60 minutes after the meal it was 21.5 +/- 0.8 mm Hg and 20.5 +/- 0.8 mm Hg, respectively (both P < 0.01 vs. baseline). Cardiac index (CI) was 4.5 +/- 0.2, 4.8 +/- 0.2, and 4.9 +/- 0.2 L x min(-1) x m(-2), respectively (both P < 0.05 vs. baseline). Peripheral vascular resistance was 1012 +/- 56, 902 +/- 51 (P = NS), and 884 +/- 49 dynes x sec x cm(-5) (P< 0.05 vs. baseline), respectively. Second study: Propranolol and placebo did not blunt postprandial increase in portal pressure. Octreotide (100 microg) partially ameliorated postprandial increase in portal pressure. Octreotide (200 microg) significantly enhanced the portal hypotensive effect of propranolol and blunted the postprandial increase in portal pressure. CONCLUSIONS Octreotide blunts postprandial increase in portal pressure not prevented by long-term propranolol administration.
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Affiliation(s)
- Julio D Vorobioff
- Liver Unit and Hepatic Hemodynamic Laboratory, Fundación Dr. J. R. Villavicencio & Sanatorio Parque, Rosario, Argentina.
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Sugano S, Yamamoto K, Atobe T, Watanabe M, Wakui N, Iwasaki N, Toyota M. Postprandial middle cerebral arterial vasoconstriction in cirrhotic patients. A placebo, controlled evaluation. J Hepatol 2001; 34:373-7. [PMID: 11322197 DOI: 10.1016/s0168-8278(00)00035-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS The objective of this study was to determine whether cerebral arterial vasoconstriction occurs in relation to postprandial splanchnic blood pooling in cirrhotic patients. METHODS The pulsatility and the resistive indexes and blood flow in the middle cerebral artery were measured by magnetic resonance imaging in 21 cirrhotics and 14 controls. These measurements were repeated 30 min after ingestion of a 400 kcal liquid meal or placebo. Seven controls and 14 patients received the meal, and seven controls and seven patients received placebo. RESULTS In the fasting conditions, cirrhotics had a greater pulsatility index (0.81 +/- 0.10 vs. 0.67 +/- 0.05, P < 0.001) and a greater resistive index (0.61 +/- 0.04 vs. 0.53 +/- 0.04, P < 0.001) and a lower blood flow (127 +/- 42 ml/min vs. 167 +/- 37 ml/min, P < 0.03) in the middle cerebral artery compared with controls. Meal ingestion significantly increased the pulsatility index (P < 0.03) and the resistive index (P < 0.01) and decreased blood flow (P < 0.03) in the middle cerebral artery in cirrhotics but not in controls. In contrast, placebo ingestion had no effect on the hemodynamic parameters in the middle cerebral artery in the two groups. CONCLUSIONS Results support the hypothesis that middle cerebral arterial vasoconstriction seen in cirrhotic patients is one of the cerebral artery's homeostatic responses to underfilling of the splanchnic arterial circulation.
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Affiliation(s)
- S Sugano
- Department of Internal Medicine, Saiseikai Wakakusa Hospital, Yokohama, Japan.
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Chelimsky G, Hupertz VF, Chelimsky TC. Abdominal pain as the presenting symptom of autonomic dysfunction in a child. Clin Pediatr (Phila) 1999; 38:725-9. [PMID: 10618765 DOI: 10.1177/000992289903801205] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- G Chelimsky
- Department of Pediatrics, Rainbow Babies and Childrens Hospital, Cleveland, Ohio, USA
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Hydbring E, Cvek K, Olsson K. Telemetric registration of heart rate and blood pressure in the same unrestrained goats during pregnancy, lactation and the non-pregnant, non-lactating period. ACTA PHYSIOLOGICA SCANDINAVICA 1999; 165:135-41. [PMID: 10090324 DOI: 10.1046/j.1365-201x.1999.00498.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to investigate how changes in heart rate and arterial blood pressure relate to the time of day, reproductive period and feeding routines in dairy goats (Capra hircus). Registrations were made by radiotelemetry in the same four goats during pregnancy, lactation and the non-pregnant, non-lactating (dry) period. Heart rate rose around the morning and afternoon feedings, whereas blood pressure did not show any diurnal rhythm. Comparison between reproductive periods revealed that heart rate was higher during the fifth month of pregnancy than during lactation and the dry period, whereas for blood pressure no such differences between periods were found. Withholding three meals from lactating goats resulted in a continuous slowdown of the heart rate, whereas blood pressure fluctuated. Re-feeding temporarily increased the heart rate but had no effect on blood pressure which continued to fluctuate. After another 2 days, blood pressure (but not heart rate) had stabilized. Food-restriction, aimed at terminating milk production resulted in a consistently depressed heart rate and reduced the mean and systolic blood pressures at night. The results show that with this implantable telemetry device it is possible to measure both heart rate and blood pressure day and night in the same unrestrained animals over a length of time long enough to include all reproductive periods. Our results emphasize that when planning experiments it is important that the exact stage in each reproductive period, the act of feeding and the amount of food given be taken into account.
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Affiliation(s)
- E Hydbring
- Department of Animal Physiology, Swedish University of Agricultural Sciences, Uppsala
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Affiliation(s)
- A.W. Yu
- Department of Medicine, Alice Nethersole Tai Po Hospital Hong Kong - China
| | - K.N. Lai
- Department of Medicine, University of Hong Kong, Hong Kong - China
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Figueras J, Domingo E. Fasting and postprandial ischemic threshold in patients with unstable angina with and without postprandial angina at rest. Am Heart J 1998; 136:252-8. [PMID: 9704686 DOI: 10.1053/hj.1998.v136.89585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Postprandial angina develops within minutes after a meal in patients with unstable angina, but the clinical characteristics of these patients and why it develops in only some of those with advanced coronary artery disease remain largely unknown. A severely reduced coronary reserve associated with postprandial increases in heart rate could be a contributory mechanism. METHODS The clinical and angiographic characteristics of 277 patients with unstable angina with (23) or without (254) postprandial angina were analyzed. The coronary reserve was also analyzed by measuring the ischemic threshold by atrial pacing in a fasting state in all patients and 15 minutes after a 900-calorie meal in 54. RESULTS Patients with postprandial angina were older, more likely to be women, and had a higher incidence of hypertension and three-vessel disease than those without (p < 0.005) and had a lower fasting ischemic threshold (131.8 [SD 13.0] vs 147.5 [SD 23.4] beats/min, p < 0.0001). However, 67 of the 79 patients with the lowest fasting thresholds (< or =130 beats/min) (84.8%) had no postprandial angina. Moreover, among patients with and without postprandial angina who were matched for age, sex, and extent of coronary disease, the ischemic threshold was also lower in those with postprandial angina (p < 0.005) and there were no differences in left ventricular end-diastolic pressure or volume. Postprandial pacing was positive in 37 patients but postprandial ischemic threshold was comparable to fasting threshold (132 [SD 14] vs 132 [SD 16] beats/min). Moreover, in the 10 patients who experienced in-hospital postprandial angina, heart rate during postprandial angina was similar to nonpostprandial angina (93.1 [SD 14.7] vs 90.3 [SD 17.6]) and lower than the fasting ischemic threshold (132.0 [SD 10.8] beats/min, p < 0.0001). CONCLUSIONS Thus postprandial angina tends to occur among elderly and hypertensive patients with advanced coronary disease and severely reduced ischemic threshold. The fact that the postprandial ischemic threshold was clearly higher than the heart rate attained during postprandial angina suggest that factors others than increases in heart rate account for postprandial angina. Furthermore, the lack of a decline in the postprandial ischemic threshold suggests that, in the absence of postprandial angina, there is not a consistent postprandial change in coronary tone or that the increases in myocardial oxygen demands due to increased myocardial contractility-wall tension do not seem to play a major role in postprandial ischemia.
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Affiliation(s)
- J Figueras
- Unitat Coronària, Servei de Cardiologia, Hospital General Vall d'Hebron, Barcelona, Spain
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