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Pucci G, Spronck B, Avolio AP, Tap L, Vaudo G, Anastasio F, Van Den Meiracker A, Mattace-Raso F. Age-Specific Acute Changes in Carotid-Femoral Pulse Wave Velocity With Head-up Tilt. Am J Hypertens 2020; 33:1112-1118. [PMID: 32634245 PMCID: PMC7814224 DOI: 10.1093/ajh/hpaa101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Aortic stiffness as measured by carotid-femoral pulse wave velocity (cfPWV) is known to depend on blood pressure (BP), and this dependency may change with age. Therefore, the hydrostatic BP gradient resulting from a change in body posture may elicit a cfPWV change that is age-dependent. We aimed to analyze the relationship between BP gradient-induced by head-up body tilting-and related changes in cfPWV in individuals of varying age. METHODS cfPWV and other hemodynamic parameters were measured in 30 healthy individuals at a head-up tilt of 0° (supine), 30°, and 60°. At each angle, the PWV gradient and resulting cfPWV were also estimated (predicted) by assuming a global nonlinear, exponential, pressure-diameter relationship characterized by a constant β0, and taking into account that (diastolic) foot-to-foot cfPWV acutely depends on diastolic BP. RESULTS cfPWV significantly increased upon body tilting (8.0 ± 2.0 m/s supine, 9.1 ± 2.6 m/s at 30°, 9.5 ± 3.2 m/s at 60°, P for trend <0.01); a positive trend was also observed for heart rate (HR; P < 0.01). When the observed, tilt-induced cfPWV change measured by applanation tonometry was compared with that predicted from the estimated BP hydrostatic gradient, the difference in observed-vs.-predicted PWV change increased nonlinearly as a function of age (R2 for quadratic trend = 0.38, P < 0.01, P vs. linear = 0.04). This result was unaffected by HR tilt-related variations (R2 for quadratic trend = 0.37, P < 0.01, P vs. linear = 0.04). CONCLUSIONS Under a hydrostatic pressure gradient, the pulse wave traveling along the aorta undergoes an age-related, nonlinear PWV increase exceeding the increase predicted from BP dependency.
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Affiliation(s)
- Giacomo Pucci
- Department of Medicine, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Terni, Italy
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Bart Spronck
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Alberto P Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Lisanne Tap
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Gaetano Vaudo
- Department of Medicine, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Fabio Anastasio
- Unit of Cardiology, ASST-VAL Hospital of Sondrio, Sondrio, Italy
| | - Anton Van Den Meiracker
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Francesco Mattace-Raso
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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A brief bout of exercise in hypoxia reduces ventricular filling rate and stroke volume response during muscle metaboreflex activation. Eur J Appl Physiol 2020; 120:2115-2126. [PMID: 32683489 PMCID: PMC7419479 DOI: 10.1007/s00421-020-04435-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/10/2020] [Indexed: 01/20/2023]
Abstract
Purpose The hemodynamic consequences of exercise in hypoxia have not been completely investigated. The present investigation aimed at studying the hemodynamic effects of contemporary normobaric hypoxia and metaboreflex activation. Methods Eleven physically active, healthy males (age 32.7 ± 7.2 years) completed a cardiopulmonary test on an electromagnetically braked cycle-ergometer to determine their maximum workload (Wmax). On separate days, participants performed two randomly assigned exercise sessions (3 minutes pedalling at 30% of Wmax): (1) one in normoxia (NORMO), and (2) one in normobaric hypoxia with FiO2 set to 13.5% (HYPO). After each session, the following protocol was randomly assigned: either (1) post-exercise muscle ischemia (PEMI) to study the metaboreflex, or (2) a control exercise recovery session, i.e., without metaboreflex activation. Hemodynamics were assessed with impedance cardiography. Results The main result was that the HYPO session impaired the ventricular filling rate (measured as stroke volume/diastolic time) response during PEMI versus control condition in comparison to the NORMO test (31.33 ± 68.03 vs. 81.52 ± 49.23 ml·s−1,respectively, p = 0.003). This caused a reduction in the stroke volume response (1.45 ± 9.49 vs. 10.68 ± 8.21 ml, p = 0.020). As a consequence, cardiac output response was impaired during the HYPO test. Conclusions The present investigation suggests that a brief exercise bout in hypoxia is capable of impairing cardiac filling rate as well as stroke volume during the metaboreflex. These results are in good accordance with recent findings showing that among hemodynamic modulators, ventricular filling is the most sensible variable to hypoxic stimuli.
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Effects of exercise in normobaric hypoxia on hemodynamics during muscle metaboreflex activation in normoxia. Eur J Appl Physiol 2019; 119:1137-1148. [DOI: 10.1007/s00421-019-04103-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 02/13/2019] [Indexed: 01/21/2023]
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Mulliri G, Sainas G, Magnani S, Palazzolo G, Milia N, Orrù A, Roberto S, Marongiu E, Milia R, Crisafulli A. Ischemic preconditioning reduces hemodynamic response during metaboreflex activation. Am J Physiol Regul Integr Comp Physiol 2016; 310:R777-87. [PMID: 26936782 DOI: 10.1152/ajpregu.00429.2015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/01/2016] [Indexed: 11/22/2022]
Abstract
Ischemic preconditioning (IP) has been shown to improve exercise performance and to delay fatigue. However, the precise mechanisms through which IP operates remain elusive. It has been hypothesized that IP lowers the sensation of fatigue by reducing the discharge of group III and IV nerve endings, which also regulate hemodynamics during the metaboreflex. We hypothesized that IP reduces the blood pressure response during the metaboreflex. Fourteen healthy males (age between 25 and 48 yr) participated in this study. They underwent the following randomly assigned protocol: postexercise muscle ischemia (PEMI) test, during which the metaboreflex was elicited after dynamic handgrip; control exercise recovery session (CER) test; and PEMI after IP (IP-PEMI) test. IP was obtained by occluding forearm circulation for three cycles of 5 min spaced by 5 min of reperfusion. Hemodynamics were evaluated by echocardiography and impedance cardiography. The main results were that after IP the mean arterial pressure response was reduced compared with the PEMI test (means ± SD +3.37 ± 6.41 vs. +9.16 ± 7.09 mmHg, respectively). This was the consequence of an impaired venous return that impaired the stroke volume during the IP-PEMI more than during the PEMI test (-1.43 ± 15.35 vs. +10.28 ± 10.479 ml, respectively). It was concluded that during the metaboreflex, IP affects hemodynamics mainly because it impairs the capacity to augment venous return and to recruit the cardiac preload reserve. It was hypothesized that this is the consequence of an increased nitric oxide production, which reduces the possibility to constrict venous capacity vessels.
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Affiliation(s)
- Gabriele Mulliri
- Department of Medical Sciences, Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - Gianmarco Sainas
- Department of Medical Sciences, Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - Sara Magnani
- Department of Medical Sciences, Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - Girolamo Palazzolo
- Department of Medical Sciences, Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - Nicola Milia
- Department of Medical Sciences, Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - Andrea Orrù
- Department of Medical Sciences, Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - Silvana Roberto
- Department of Medical Sciences, Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - Elisabetta Marongiu
- Department of Medical Sciences, Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - Raffaele Milia
- Department of Medical Sciences, Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - Antonio Crisafulli
- Department of Medical Sciences, Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
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Kim BG, Cho SW, Lee HY, Kim DH, Byun YS, Goh CW, Rhee KJ, Kim BO. Reduced systemic vascular resistance is the underlying hemodynamic mechanism in nitrate-stimulated vasovagal syncope during head-up tilt-table test. J Arrhythm 2015; 31:196-200. [PMID: 26336559 DOI: 10.1016/j.joa.2014.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/21/2014] [Accepted: 11/26/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nitroglycerin (NTG) challenge during head-up tilt-table testing (HUTT) is often utilized to determine the etiology of unexplained vascular syncope. However, conflicting results concerning nitrate-induced hemodynamic changes during HUTT have been reported. The purpose of this study was to assess the determinants of presyncopal symptoms during NTG-stimulated HUTT. METHODS We evaluated 40 patients with suspected vasovagal syncope. Beat-to-beat changes in blood pressure, heart rate (HR), cardiac index (CI), and systemic vascular resistance (SVR) during HUTT were measured with thoracic impedance cardiography and a plethysmographic finger arterial pressure monitoring device. RESULTS None of the 40 patients complained of presyncopal symptoms during passive HUTT. However, after the administration of NTG 28 patients showed presyncopal symptoms (NTG+ group) and the remaining 12 patients did not (NTG- group). HR, CI, and the stroke index did not significantly differ between the two groups, whereas mean arterial pressure and SVR were significantly lower in the NTG+ group. CONCLUSIONS Presyncopal symptoms during NTG-stimulated HUTT are SVR mediated, not cardiac output mediated. This study challenges the conventional idea of a decrease in cardiac output mediated by NTG as the overriding cause of presyncopal symptoms during HUTT.
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Affiliation(s)
- Byung Gyu Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Sung Woo Cho
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea ; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Hye Young Lee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Deok Hee Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Choong Won Goh
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Kun Joo Rhee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
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Marongiu E, Piepoli M, Milia R, Angius L, Pinna M, Bassareo P, Roberto S, Tocco F, Concu A, Crisafulli A. Effects of acute vasodilation on the hemodynamic response to muscle metaboreflex. Am J Physiol Heart Circ Physiol 2013; 305:H1387-96. [PMID: 23997095 DOI: 10.1152/ajpheart.00397.2013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of the present study was to test the contribution of stroke volume (SV) in hemodynamic response to muscle metaboreflex activation in healthy individuals. We hypothesized that an acute decrease in cardiac afterload and preload due to the administration of a vasodilating agent could reduce postexercise muscle ischemia (PEMI)-induced SV response. Ten healthy males (age 33.6 ± 1.3 yr) were enrolled and randomly assigned to the following study protocol: 1) PEMI session, 2) control exercise recovery (CER) session, 3) PEMI after sublingual administration of 5 mg of isosorbide dinitrate (ISDN), and 4) CER after ISDN. Central hemodynamics were evaluated by means of impedance cardiography. The main findings were a blunted SV response during metaboreflex following acute arterial and venous vasodilation, associated with a reduction in cardiac diastolic time and filling, and a decrement of systemic vascular resistance. These hemodynamic changes restrain blood pressure response during metaboreflex activation. Our results indicate that hemodynamic response to metaboreflex activation is a highly integrated phenomenon encompassing complex interplay between heart rate, cardiac performance, preload, and afterload and that impairment of one or more of these parameters leads to altered hemodynamic response to metaboreflex.
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Affiliation(s)
- Elisabetta Marongiu
- Department of Medical Sciences, Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
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Macedo P, Leite LR, Asirvatham SJ, Hachul DT, Dos Santos-Neto LL, Shen WK. Head Up Tilt Testing: An Appraisal of Its Current Role in the Management of Patients with Syncope. J Atr Fibrillation 2011; 4:333. [PMID: 28496692 DOI: 10.4022/jafib.333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 12/19/2010] [Accepted: 01/14/2011] [Indexed: 01/14/2023]
Abstract
Head up tilt testing (HTT) is now commonly used to investigate otherwise unexplained syncope and presyncope. This test has been used for over 20 years primarily to diagnose neurally mediated syncope, but HTT's exact role in the diagnostic process remains uncertain. Recognized limitations include poor reproducibility, lack of prognostic role, and insufficient randomized studies to guide therapeutic choice. In this review, we describe the indications and methods recommended by present guidelines on utilizing HTT. In addition, present criticisms and limitations of this test, along with future perspectives, are outlined.
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Affiliation(s)
- Paula Macedo
- Division of Cardiovascular Diseases, Department of Medicine
| | | | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Medicine.,Department of Pediatrics and Adolescent Medicine - Mayo Clinic, Rochester, Minnesota
| | | | | | - Win-Kuang Shen
- Division of Cardiovascular Diseases, Department of Medicine
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Tahvanainen A, Koskela J, Leskinen M, Ilveskoski E, Nordhausen K, Kähönen M, Kööbi T, Mustonen J, Pörsti I. Reduced systemic vascular resistance in healthy volunteers with presyncopal symptoms during a nitrate-stimulated tilt-table test. Br J Clin Pharmacol 2011; 71:41-51. [PMID: 21143500 DOI: 10.1111/j.1365-2125.2010.03794.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Nitrates may facilitate syncope through various pathways, but the precise mechanism of nitrate-induced syncope is still under debate. The purpose of the present study was to compare the underlying haemodynamic mechanisms in subjects without and with presyncopal symptoms during a nitroglycerin-stimulated tilt-table test. WHAT THIS STUDY ADDS A major decrease in systemic vascular resistance was documented in subjects with presyncope during 0.25 mg nitroglycerin-stimulated tilt-table test, in the absence of changes in cardiac output. These findings indicated that even a small dose of nitroglycerin significantly decreased arterial resistance and cardiac afterload. AIMS The mechanism of nitrate-induced syncope remains controversial. We examined the haemodynamic changes in healthy volunteers during nitroglycerin-stimulated tilt-table test. METHODS Continuous radial pulse wave analysis, whole-body impedance cardiography and plethysmographic finger blood pressure were recorded in a supine position and during head-up tilt in 21 subjects with presyncopal symptoms (6 male/15 female, age 43 ± 3 years) after 0.25 mg sublingual nitroglycerin and 21 control subjects (6 male/15 female, age 43 ± 2 years). The drug was administered in the supine position and a passive head-up tilt followed 5 min later. Additionally, nitroglycerin was only administered during head-up tilt in 19 subjects and the haemodynamics were recorded. RESULTS Supine and upright haemodynamics were similar before nitroglycerin administration in the two groups. During the nitroglycerin-stimulated tilt test, aortic and radial mean blood pressure decreased significantly more in the presyncope group when compared with the controls (P= 0.0006 and P= 0.0004, respectively). The decreases in systemic vascular resistance (P= 0.0008) and heart rate (P= 0.002), and increase in aortic reflection time (P= 0.0002) were greater in the presyncope group, while the change in cardiac index was not different between the groups (P= 0.14). If nitroglycerin was administered during the upright tilt and not in supine position, the haemodynamic changes were quite corresponding. CONCLUSIONS Presyncopal symptoms during nitrate-stimulated tilt test were explained by decreased systemic vascular resistance and increased aortic reflection time, while cardiac output remained unchanged. These findings indicated reduced arterial resistance in nitroglycerin-induced presyncope.
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Affiliation(s)
- Anna Tahvanainen
- Department of Internal Medicine, Tampere School of Public Health, University of Tampere, Tampere, Finland.
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Mitro P, Spegár J. Dynamic changes of P-wave duration and P-wave axis during head-up tilt test in patients with vasovagal syncope. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:742-6. [PMID: 16884510 DOI: 10.1111/j.1540-8159.2006.00428.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The exact role of venous pooling in the pathogenesis of vasovagal syncope (VVS) is not fully elucidated. P-wave duration on an electrocardiogram can serve as a measure of atrial volume. METHODS Sixty-six patients (15 men, 51 women, mean age 32 years) with unexplained syncope were enrolled in the study.P-wave duration and the P-wave axis (PWA) were measured during passive head-up tilt test (HUT) in order to evaluate dynamic changes of atrial filling in patients with VVS. RESULTS HUT was positive in 40 patients (6 men, 34 women, mean age 32 +/- 9 years) and negative in 26 patients (9 men, 17 women, mean age 33 +/- 8 years). The P-wave duration was significantly reduced in HUT-positive patients at the onset of symptoms as compared to 5 minutes (88.8 +/- 11.9 vs 96.2 +/- 12.0 ms, P = 0.008), and baseline (88.8 +/- 11.9 vs 96.8 +/- 13.8 ms, P = 0.005). The P-wave duration was significantly shorter at the onset of presyncope in HUT-positive patients as compared to HUT-negative patients (88.8 +/- 11.9 vs 100.3 +/- 11.2 ms, P = 0.0002). In HUT-positive patients, a significant increase in PWA was found at the onset of symptoms when compared to baseline (67.7 +/- 22.1 degrees vs 47.9 +/- 14.9 degrees, P < 0.0001) and 5 minutes of HUT (67.7 +/- 22.1 degrees vs 54.4 +/- 14.9 degrees, P = 0.005). At the time of syncope, PWA was more inferior in HUT-positive patients than in HUT-negative patients (67.7 +/- 22.1 degrees vs 51.8 +/- 13.8 degrees, P = 0.015). CONCLUSIONS VVS is associated with the reduction in P-wave duration and the increase in PWA, which can be a result of exaggerated venous pooling and reduction in atrial volume.
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Affiliation(s)
- Peter Mitro
- Clinic of Internal Medicine III, Medical Faculty of P.J. Safarik University, Kosice, Slovakia.
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Affiliation(s)
- Arnaud J J Aerts
- Department of Cardiology, Atrium Medisch Centrum Heerlen, the Netherlands.
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