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Embaby A, Heinhuis KM, IJzerman NS, Koenen AM, van der Kleij S, Hofland I, van Boven H, Sanders J, van der Graaf WTA, Haas RL, Huitema ADR, van Houdt WJ, Steeghs N. Propranolol monotherapy in angiosarcoma - A window-of-opportunity study (PropAngio). Eur J Cancer 2024; 202:113974. [PMID: 38452721 DOI: 10.1016/j.ejca.2024.113974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Angiosarcoma is a rare and aggressive cancer of the endothelial cells. Propranolol, a non-selective β-blocker, was able to initiate apoptosis in angiosarcoma cell lines and its anti-tumor activity has been described in several case reports. The aim of this trial was to prospectively evaluate the anti-tumor activity of propranolol monotherapy in patients with angiosarcoma before proceeding to standard of care treatment. METHODS Propranolol was dosed 80 mg to 240 mg/day for 3 to 6 weeks according to a dose titration schedule. The primary endpoint was clinical response (response according to RECIST 1.1 or stable disease with improvement of cutaneous lesions) in at least three patients. Exploratory objectives included histologic response (>30% decrease in Ki-67), FDG PET response, and β-receptor expression levels. RESULTS Fourteen patients were enrolled. The median duration of treatment was 26 days (range 21-42 days). The median highest propranolol dose was 160 mg/day (range 80 - 240 mg). Two patients showed clinical response (14%, 95% CI 3-100%). One of these patients showed a partial metabolic response on PET-CT. None of the tumors showed histologic response. The most common adverse event was grade 1/2 bradycardia (86%). There were no grade ≥ 3 adverse events. ADRB2 was overexpressed in 16 out of 18 tumors, in both responders and non-responders. None of the tumors showed ADRB1 overexpression. CONCLUSIONS This window-of-opportunity trial did not show clinical efficacy of propranolol monotherapy. However, two out of 14 patients did show clinical benefit. ADRB1/2 expression did not correlate with clinical response.
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Affiliation(s)
- Alaa Embaby
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands; Department of Clinical Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands.
| | - Kimberley M Heinhuis
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands; Department of Clinical Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Nikki S IJzerman
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands; Department of Clinical Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Anne Miek Koenen
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Stephanie van der Kleij
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Ingrid Hofland
- Core Facility Molecular Pathology & Biobanking, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Hester van Boven
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Joyce Sanders
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Rick L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands; Department of Pharmacology, Princess Màxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
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Soma J. Can the hemodynamic model in heart failure be restored based on analysis of ventricular-arterial coupling? Heart Fail Rev 2024; 29:463-464. [PMID: 38040918 DOI: 10.1007/s10741-023-10374-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
The hemodynamic model was inappropriate to explain the disappointing effect of vasodilation and the beneficial effect of beta-blockade in chronic heart failure. A more nuanced hemodynamic analysis, taking both steady and pulsatile hemodynamics into consideration, improves insight into these apparently enigmatic effects. Of particular interest is the velocity of early systolic flow as a determinant of left ventricular afterload. Several drugs, in particular beta-blockers, directly or indirectly, influence the velocity of early systolic flow. Thus, the hemodynamic model in heart failure may deserve reconsideration.
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Affiliation(s)
- Johannes Soma
- Consulting Cardiologist, Medical Department, Section of Cardiology, Central Hospital Vestfold, Tønsberg, 3103, Norway.
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Abstract
BACKGROUND The benefit of beta-blockade on postoperative outcome remains controversial, though recent studies have suggested a role during major non-cardiac surgery. The benefit of beta-blockade during minimally invasive gastric bypass surgery remains unclear. The aim of the present study was to evaluate the possible association between preoperative beta-blocker therapy and postoperative outcome after laparoscopic gastric bypass surgery. METHODS Patients operated with primary laparoscopic gastric bypass surgery in Sweden between 2007 and 2017 were identified through the Scandinavian Obesity Surgery Registry. The dataset was linked to the Swedish National Patient Registry, the Swedish Prescribed Drug Registry, and Statistics Sweden. The main outcome was serious postoperative complication within 30 days of surgery; with postoperative complication, 90-day and 1-year mortality, and weight loss at 2 years after surgery as secondary endpoints. The Poisson regression model was used to evaluate primary and secondary categorical outcomes. A general mixed model was performed to evaluate 2-year weight loss. RESULTS In all, 50281 patients were included in the study. No difference was seen between patients on beta-blockade and the control group regarding postoperative complications (adjusted incidence rate ratio 1.04 (95%CI 0.93-1.15), p = 0.506), serious postoperative complication (adjusted IRR 1.06 95%CI 0.89-1.27), p = 0.515), 90-day mortality (adjusted IRR 0.71 (95%CI 0.24-2.10), p = 0.537), and 1-year mortality (adjusted IRR 1.26 (95%CI 0.67-2.36), p = 0.467). Weight loss 2 years after surgery was slightly greater in patients on beta-blockade (adjusted coefficient 0.53 (95%CI 0.19-0.87), p = 0.002). CONCLUSIONS Beta-blockade has limited impact on postoperative outcome after laparoscopic gastric bypass surgery.
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Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden.
| | - Shahin Mohseni
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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Chin SH, Allen E, Brack KE, Ng GA. Effects of sympatho-vagal interaction on ventricular electrophysiology and their modulation during beta-blockade. J Mol Cell Cardiol 2020; 139:201-212. [PMID: 32004506 DOI: 10.1016/j.yjmcc.2020.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 11/16/2022]
Abstract
AIMS The effects of sympatho-vagal interaction on heart rate (HR) changes are characterized by vagal dominance resulting in accentuated antagonism. Complex autonomic modulation of ventricular electrophysiology may exert prognostic arrhythmic impact. We examined the effects of concurrent sympathetic (SNS) and vagus (VNS) nerve stimulation on ventricular fibrillation threshold (VFT) and standard restitution (RT) in an isolated rabbit heart preparation with intact dual autonomic innervation, with and without beta-blockade. METHODS AND RESULTS Monophasic action potentials were recorded from left ventricular epicardial surface of dual-innervated isolated heart preparations from New Zealand white rabbits (n = 18). HR, VFT and RT were measured during different stimulation protocols (Protocol 1: VNS-SNS; Protocol 2: SNS-VNS) involving low- and high-frequency stimulations. A sub-study of Protocol 2 was performed in the presence of metoprolol tartrate. In both protocols, HR changes were characterized by vagal-dominant bradycardic component, affirming accentuated antagonism. During concurrent high-frequency VNS (HV), SNS prevails in lowering VFT in a frequency-sensitive manner during low (LS) or high (HS)-frequency stimulations (HV-LS: -2.8 ± 0.8 mA; HV-HS: -4.0 ± 0.9 mA, p < .05 vs. HV), with accompanying steepening of relative RT slope gradients (HV-LS: 223.54 ± 37.41%; HV-HS: 295.20 ± 60.86%, p < .05 vs. HV). In protocol 2, low (LV) and high (HV) vagal stimulations during concurrent HS raised VFT (HS-LV: 1.0 ± 0.4 mA; HS-HV: 3.0 ± 0.6 mA, p < .05 vs HS) with associated flattening of RT slopes (HS-LV: 32.40 ± 4.97%;HS-HV: 38.07 ± 6.37%; p < .05 vs HS). Metoprolol abolished accentuated antagonism in HR changes, reduced VFT and flattened RT globally during SNS-VNS. CONCLUSIONS Accentuated antagonism is absent in ventricular electrophysiological changes during sympatho-vagal interaction with sympathetic effect prevailing, suggesting a different mechanism at the ventricular level from heart rate effects. Metoprolol nullified accentuated antagonism with additional anti-fibrillatory effect beyond adrenergic blockade during sympatho-vagal stimulations.
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Affiliation(s)
- Shui Hao Chin
- Cardiology group, Department of Cardiovascular Sciences, University of Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Emily Allen
- Cardiology group, Department of Cardiovascular Sciences, University of Leicester, UK
| | - Kieran E Brack
- Cardiology group, Department of Cardiovascular Sciences, University of Leicester, UK
| | - G André Ng
- Cardiology group, Department of Cardiovascular Sciences, University of Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre, Leicester, UK.
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Chang SL, Chang CT, Hung WT, Chen LK. A case of congenital long QT syndrome, type 8, undergoing laparoscopic hysterectomy with general anesthesia. Taiwan J Obstet Gynecol 2019; 58:552-556. [PMID: 31307750 DOI: 10.1016/j.tjog.2019.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Patients with Long QT syndrome (LQTS) P may present with torsades de pointes, ventricular tachycardia (VT), or ventricular fibrillation (VF) and are at risk of sudden cardiac death. MATERIALS AND METHODS A 38 y/o female patient with uterus myoma developed VF during laparoscopic assisted vaginal hysterectomy surgery. Defibrillation was delivered and the electrocardiogram (ECG) returned to sinus rhythm after CPR. RESULTS Patient survived and implantable cardioverter-defibrillator was implanted and received beta-blocker therapy. ECG obtained in out-patient clinic still showed QT interval prolongation, but revealed no prolongation few months after persistent beta-blocker therapy. LQTS type 8 (CACNA1C E768del mutation) was identified by genetic DNA sequencing study. CONCLUSIONS Patients with concealed LQTS may have normal QT interval unless exposing to stress or specific stimuli. Unexpected ventricular arrhythmia may happen during any medical management. We should avoid triggers of QT prolongation, and get familiar with management of the episode.
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Affiliation(s)
- Shih-Lun Chang
- Department of Anesthesiology, Fu Jen Catholic University Hospital, No.69, Guizi Rd., Taishan Dist., New Taipei City 243, Taiwan.
| | - Ching-Tao Chang
- Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, No.25, Ln. 442, Sec. 1, Jingguo Rd., East Dist., Hsinchu City 300, Taiwan.
| | - Wei-Te Hung
- Department of Anesthesiology, Chung Shan Medical University, Taichung City, Taiwan; Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung City, Taiwan.
| | - Li-Kuei Chen
- Department of Anesthesiology, Chung Shan Medical University, Taichung City, Taiwan; Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung City, Taiwan.
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Westerhof BE, Saouti N, van der Laarse WJ, Westerhof N, Vonk Noordegraaf A. Treatment strategies for the right heart in pulmonary hypertension. Cardiovasc Res 2018; 113:1465-1473. [PMID: 28957540 PMCID: PMC5852547 DOI: 10.1093/cvr/cvx148] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/01/2017] [Indexed: 02/06/2023] Open
Abstract
The function of the right ventricle (RV) determines the prognosis of patients with pulmonary hypertension. While much progress has been made in the treatment of pulmonary hypertension, therapies for the RV are less well established. In this review of treatment strategies for the RV, first we focus on ways to reduce wall stress since this is the main determinant of changes to the ventricle. Secondly, we discuss treatment strategies targeting the detrimental consequences of increased RV wall stress. To reduce wall stress, afterload reduction is the essential. Additionally, preload to the ventricle can be reduced by diuretics, by atrial septostomy, and potentially by mechanical ventricular support. Secondary to ventricular wall stress, left-to-right asynchrony, altered myocardial energy metabolism, and neurohumoral activation will occur. These may be targeted by optimising RV contraction with pacing, by iron supplement, by angiogenesis and improving mitochondrial function, and by neurohumoral modulation, respectively. We conclude that several treatment strategies for the right heart are available; however, evidence is still limited and further research is needed before clinical application can be recommended.
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Affiliation(s)
- Berend E Westerhof
- Department of Pulmonary Diseases, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.,Department of Medical Biology, Academic Medical Center, Amsterdam, The Netherlands
| | - Nabil Saouti
- Department of Cardio-Thoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Willem J van der Laarse
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Nico Westerhof
- Department of Pulmonary Diseases, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Diseases, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Ahl R, Sjolin G, Mohseni S. Does early beta-blockade in isolated severe traumatic brain injury reduce the risk of post traumatic depression? Injury 2017; 48:101-105. [PMID: 27817882 DOI: 10.1016/j.injury.2016.10.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/09/2016] [Accepted: 10/28/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Depressive symptoms occur in approximately half of trauma patients, negatively impacting on functional outcome and quality of life following severe head injury. Pontine noradrenaline has been shown to increase upon trauma and associated β-adrenergic receptor activation appears to consolidate memory formation of traumatic events. Blocking adrenergic activity reduces physiological stress responses during recall of traumatic memories and impairs memory, implying a potential therapeutic role of β-blockers. This study examines the effect of pre-admission β-blockade on post-traumatic depression. METHODS All adult trauma patients (≥18 years) with severe, isolated traumatic brain injury (intracranial Abbreviated Injury Scale score (AIS) ≥3 and extracranial AIS <3) were recruited from the trauma registry of an urban university hospital between 2007 and 2011. Exclusion criteria were in-hospital deaths and prescription of antidepressants up to one year prior to admission. Pre- and post-admission β-blocker and antidepressant therapy data was requested from the national drugs registry. Post-traumatic depression was defined as the prescription of antidepressants within one year of trauma. Patients with and without pre-admission β-blockers were matched 1:1 by age, gender, Glasgow Coma Scale, Injury Severity Score and head AIS. Analysis was carried out using McNemar's and Student's t-test for categorical and continuous data, respectively. RESULTS A total of 545 patients met the study criteria. Of these, 15% (n=80) were prescribed β-blockers. After propensity matching, 80 matched pairs were analyzed. 33% (n=26) of non β-blocked patients developed post-traumatic depression, compared to only 18% (n=14) in the β-blocked group (p=0.04). There were no significant differences in ICU (mean days: 5.8 (SD 10.5) vs. 5.6 (SD 7.2), p=0.85) or hospital length of stay (mean days: 21 (SD 21) vs. 21 (SD 20), p=0.94) between cohorts. CONCLUSION β-blockade appears to act prophylactically and significantly reduces the risk of post-traumatic depression in patients suffering from isolated severe traumatic brain injuries. Further prospective randomized studies are warranted to validate this finding.
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Affiliation(s)
- Rebecka Ahl
- Karolinska University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, 171 76, Stockholm, Sweden; School of Medical Sciences, Orebro University, Fakultetsgatan 1, 702 81, Orebro, Sweden.
| | - Gabriel Sjolin
- Orebro University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, 701 85, Orebro, Sweden.
| | - Shahin Mohseni
- Karolinska University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, 171 76, Stockholm, Sweden; Orebro University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, 701 85, Orebro, Sweden; School of Medical Sciences, Orebro University, Fakultetsgatan 1, 702 81, Orebro, Sweden.
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Dreifus L, Engler H, Kissler J. Retrieval-induced forgetting under psychosocial stress: no reduction by delayed stress and beta-adrenergic blockade. Neurobiol Learn Mem 2014; 110:35-46. [PMID: 24486967 DOI: 10.1016/j.nlm.2014.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 01/10/2014] [Accepted: 01/14/2014] [Indexed: 11/17/2022]
Abstract
Retrieval-induced forgetting (RIF) is the phenomenon that 'retrieval-practice', the repeated retrieval of a subset of initially learned material, can impair the recall of episodically related memories. Previous studies showed that RIF is eliminated when retrieval-practice is carried out under psycho-social stress, anxiety, or in negative mood. However, pharmacological manipulation by hydrocortisone did not eliminate the effect. This study investigated the effect of beta-adrenergic blockade on stress-induced modulations of RIF, addressing possible interactive effects of the glucocorticoid and sympatho-adrenomedullary systems. Participants learned categorized word lists and then received either 60 mg propranolol or a placebo. After 90 min they were exposed to the TSST. A third group did not receive any medication and performed a non-stressful control task with the same timing as the other two groups. Finally, all participants underwent retrieval-practice and final recall. Both TSST groups exhibited a stress-induced increase in cortisol-levels, and the placebo group also exhibited large increases in markers of sympathetic nervous system activity and more psychological distress at the time of retrieval-practice. Although, overall recall was poorer under stress, an overall RIF effect emerged irrespective of group and showed no clear modulation by stress with or without beta-adrenergic blockade. In previous demonstrations of RIF elimination by negative emotion, state induction and retrieval-practice followed very briefly after initial learning. Given that both the previous study of hydrocortisone effects on RIF and the present study used longer delays between learning and retrieval-practice, the possibility that stress effects on retrieval-practice eliminate RIF only relatively briefly after learning is discussed.
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Affiliation(s)
- Laura Dreifus
- Department of Psychology, University of Konstanz, 78457 Konstanz, Germany.
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Johanna Kissler
- Department of Psychology and Physical Education, University of Bielefeld, 33501 Bielefeld, Germany
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Hellyer J, George Akingba A, Rhee KS, Tan AY, Lane KA, Shen C, Patel J, Fishbein MC, Chen PS. Autonomic nerve activity and blood pressure in ambulatory dogs. Heart Rhythm 2013; 11:307-13. [PMID: 24275433 DOI: 10.1016/j.hrthm.2013.11.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND The relationship between cardiac autonomic nerve activity and blood pressure (BP) changes in ambulatory dogs is unclear. OBJECTIVE The purpose of this study was to test the hypotheses that simultaneous termination of stellate ganglion nerve activity (SGNA) and vagal nerve activity (VNA) predisposes to spontaneous orthostatic hypotension and that specific β₂-adrenoceptor blockade prevents the hypotensive episodes. METHODS We used a radiotransmitter to record SGNA, VNA, and BP in eight ambulatory dogs. Video imaging was used to document postural changes. RESULTS Of these eight dogs, five showed simultaneous sympathovagal discharges in which the minute-by-minute integrated SGNA correlated with integrated VNA in a linear pattern (group 1). In these dogs, abrupt termination of simultaneous SGNA-VNA at the time of postural changes (as documented by video imaging) was followed by abrupt (>20 mm Hg over four beats) drops in BP. Dogs without simultaneous on/off firing (group 2) did not have drastic drops in pressure. ICI-118,551 (ICI, a specific β₂-blocker) infused at 3 µg/kg/h for 7 days significantly increased BP from 126 mm Hg (95% confidence interval 118-133) to 133 mm Hg (95% confidence interval 125-141; P = .0001). The duration of hypotension (mean systolic BP <100 mm Hg) during baseline accounted for 7.1% of the recording. The percentage was reduced by ICI to 1.3% (P = .01). CONCLUSION Abrupt simultaneous termination of SGNA-VNA was observed at the time of orthostatic hypotension in ambulatory dogs. Selective β₂-adrenoceptor blockade increased BP and reduced the duration of hypotension in this model.
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Affiliation(s)
- Jessica Hellyer
- Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | - A George Akingba
- Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana; Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kyoung-Suk Rhee
- Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | - Alex Y Tan
- Hunter Holmes McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Kathleen A Lane
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Changyu Shen
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana; Fairbanks School of Public Health, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Jheel Patel
- Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | - Michael C Fishbein
- Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana; Department of Pathology and Laboratory Medicine, University of California, Los Angeles, California
| | - Peng-Sheng Chen
- Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana.
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