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Refisch A, Komatsuzaki S, Ungelenk M, Chung HY, Schumann A, Schilling SS, Jantzen W, Schröder S, Mühleisen TW, Nöthen MM, Hübner CA, Bär KJ. Associations of common genetic risk variants of the muscarinic acetylcholine receptor M2 with cardiac autonomic dysfunction in patients with schizophrenia. World J Biol Psychiatry 2023; 24:1-11. [PMID: 35172679 DOI: 10.1080/15622975.2022.2043561] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Decreased vagal modulation, which has consistently been observed in schizophrenic patients, might contribute to increased cardiac mortality in schizophrenia. Previously, associations between CHRM2 (Cholinergic Receptor Muscarinic 2) and cardiac autonomic features have been reported. Here, we tested for possible associations between these polymorphisms and heart rate variability in patients with schizophrenia. METHODS A total of three single nucleotide polymorphisms (SNPs) in CHRM2 (rs73158705 A>G, rs8191992 T>A and rs2350782 T>C) that achieved significance (p < 5 * 10-8) in genome-wide association studies for cardiac autonomic features were genotyped in 88 drug-naïve patients, 61 patients receiving antipsychotic medication and 144 healthy controls. Genotypes were analysed for associations with parameters of heart rate variability and complexity, in each diagnostic group. RESULTS We observed a significantly altered heart rate variability in unmedicated patients with identified genetic risk status in rs73158705 A>G, rs8191992 T>A and rs2350782 T>C as compared to genotype non-risk status. In patients receiving antipsychotic medication and healthy controls, these associations were not observed. DISCUSSION We report novel candidate genetic associations with cardiac autonomic dysfunction in schizophrenia, but larger cohorts are required for replication.
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Affiliation(s)
- Alexander Refisch
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC)1, Jena University Hospital, Jena, Germany
| | - Shoko Komatsuzaki
- Institute of Human Genetics, Jena University Hospital, Jena, Germany
| | - Martin Ungelenk
- Institute of Human Genetics, Jena University Hospital, Jena, Germany
| | - Ha-Yeun Chung
- Department of Neurology, Section Translational Neuroimmunology, Jena University Hospital, Jena, Germany
| | - Andy Schumann
- Department of Psychosomatic Medicine and Psychotherapy, Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC)1, Jena University Hospital, Jena, Germany
| | - Susann S Schilling
- Department of Psychosomatic Medicine and Psychotherapy, Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC)1, Jena University Hospital, Jena, Germany
| | - Wibke Jantzen
- Department of Psychosomatic Medicine and Psychotherapy, Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC)1, Jena University Hospital, Jena, Germany
| | - Sabine Schröder
- Department of Psychosomatic Medicine and Psychotherapy, Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC)1, Jena University Hospital, Jena, Germany
| | - Thomas W Mühleisen
- Institute of Neuroscience and Medicine (INM-1), Research Center Juelich, Juelich, Germany.,Medical Faculty, Cécile and Oskar Vogt Institute of Brain Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Department of Biomedicine, Human Genomics Research Group, University of Basel, Basel, Switzerland
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany
| | | | - Karl-Jürgen Bär
- Department of Psychosomatic Medicine and Psychotherapy, Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC)1, Jena University Hospital, Jena, Germany
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Wilkie L, Fisher Z, Kemp AH. The Complex Construct of Wellbeing and the Role of Vagal Function. Front Integr Neurosci 2022; 16:925664. [PMID: 35875509 PMCID: PMC9301262 DOI: 10.3389/fnint.2022.925664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Lowri Wilkie
- School of Psychology, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, United Kingdom
- Regional Neuropsychology and Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
| | - Zoe Fisher
- Regional Neuropsychology and Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
- Health and Wellbeing Academy, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, United Kingdom
| | - Andrew H. Kemp
- School of Psychology, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, United Kingdom
- Regional Neuropsychology and Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
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Abstract
OBJECTIVE Previous research indicates a link between burnout symptoms and reduced vagally mediated heart rate variability (HRV); however, the directionality of this relationship is still largely unknown. The objective of the present study was to examine the longitudinal relationship between HRV and burnout symptoms for 1 year, with a special focus on the emotional exhaustion (EE) burnout subdimension, which remains inadequately distinguished from overlapping with depressive symptoms. METHODS Here we present HRV and behavioral data from 167 individuals (mean [SD] age = 43.43 [11.78] years; 30.5% male) who attended two biomarker samplings (T1 and T2) of the Dresden Burnout Study approximately 12 months apart. RESULTS In hierarchical linear regression analyses, T1 HRV significantly inversely predicted T2 overall burnout symptoms (β = -.16; p = .03) and EE (β = -.23; p = .02), adjusting for age, sex, body mass index, adverse health behaviors, and depressive symptoms. Importantly, only high EE at T1 (β = -.22; p = .04), and not the T1 Maslach Burnout Inventor total score, predicted reductions in HRV from T1 to T2. CONCLUSIONS We report for the first time longitudinal evidence that HRV is associated with changes in burnout symptoms, independently of depressive symptoms. Results suggest vagal dysfunction being predictive and specific for burnout symptoms, making HRV a promising starting point for the explanation of biophysiological mechanisms underlying burnout symptoms and cardiovascular diseases. The finding of only EE at T1 being predictive for changes in HRV underscores the importance of exhaustion for modulations in autonomic regulation.
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Abbott TEF, Pearse RM, Cuthbertson BH, Wijeysundera DN, Ackland GL. Cardiac vagal dysfunction and myocardial injury after non-cardiac surgery: a planned secondary analysis of the measurement of Exercise Tolerance before surgery study. Br J Anaesth 2018; 122:188-197. [PMID: 30686304 PMCID: PMC6354047 DOI: 10.1016/j.bja.2018.10.060] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/19/2018] [Accepted: 10/20/2018] [Indexed: 12/14/2022] Open
Abstract
Background The aetiology of perioperative myocardial injury is poorly understood and not clearly linked to pre-existing cardiovascular disease. We hypothesised that loss of cardioprotective vagal tone [defined by impaired heart rate recovery ≤12 beats min−1 (HRR ≤12) 1 min after cessation of preoperative cardiopulmonary exercise testing] was associated with perioperative myocardial injury. Methods We conducted a pre-defined, secondary analysis of a multi-centre prospective cohort study of preoperative cardiopulmonary exercise testing. Participants were aged ≥40 yr undergoing non-cardiac surgery. The exposure was impaired HRR (HRR≤12). The primary outcome was postoperative myocardial injury, defined by serum troponin concentration within 72 h after surgery. The analysis accounted for established markers of cardiac risk [Revised Cardiac Risk Index (RCRI), N-terminal pro-brain natriuretic peptide (NT pro-BNP)]. Results A total of 1326 participants were included [mean age (standard deviation), 64 (10) yr], of whom 816 (61.5%) were male. HRR≤12 occurred in 548 patients (41.3%). Myocardial injury was more frequent amongst patients with HRR≤12 [85/548 (15.5%) vs HRR>12: 83/778 (10.7%); odds ratio (OR), 1.50 (1.08–2.08); P=0.016, adjusted for RCRI). HRR declined progressively in patients with increasing numbers of RCRI factors. Patients with ≥3 RCRI factors were more likely to have HRR≤12 [26/36 (72.2%) vs 0 factors: 167/419 (39.9%); OR, 3.92 (1.84–8.34); P<0.001]. NT pro-BNP greater than a standard prognostic threshold (>300 pg ml−1) was more frequent in patients with HRR≤12 [96/529 (18.1%) vs HRR>12 59/745 (7.9%); OR, 2.58 (1.82–3.64); P<0.001]. Conclusions Impaired HRR is associated with an increased risk of perioperative cardiac injury. These data suggest a mechanistic role for cardiac vagal dysfunction in promoting perioperative myocardial injury.
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Affiliation(s)
- T E F Abbott
- William Harvey Research Institute, Queen Mary University of London, London, UK; University College London Hospital, London, UK
| | - R M Pearse
- William Harvey Research Institute, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK
| | - B H Cuthbertson
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - D N Wijeysundera
- University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada
| | - G L Ackland
- William Harvey Research Institute, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK.
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Kemp AH. Editorial: Mechanisms Underpinning the Link between Emotion, Physical Health, and Longevity. Front Psychol 2017; 8:1338. [PMID: 28824515 PMCID: PMC5539222 DOI: 10.3389/fpsyg.2017.01338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/20/2017] [Indexed: 01/22/2023] Open
Affiliation(s)
- Andrew H Kemp
- Department of Psychology and the Health and Wellbeing Academy, College of Human and Health Sciences, Swansea UniversitySwansea, United Kingdom.,School of Psychology and Discipline of Psychiatry, University of SydneySydney, NSW, Australia
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Mujica-Parodi LR, Yeragani V, Malaspina D. Nonlinear complexity and spectral analyses of heart rate variability in medicated and unmedicated patients with schizophrenia. Neuropsychobiology 2005; 51:10-5. [PMID: 15627808 PMCID: PMC2983101 DOI: 10.1159/000082850] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Heart rate variability (HRV) reflects functioning of the autonomic nervous system and possibly also regulation by the neural limbic system, abnormalities of which have both figured prominently in various etiological models of schizophrenia, particularly those that address patients' vulnerability to stress in connection to psychosis onset and exacerbation. This study provides data on cardiac functioning in a sample of schizophrenia patients that were either medication free or on atypical antipsychotics, as well as cardiac data on matched healthy controls. We included a medication-free group to investigate whether abnormalities in HRV previously reported in the literature and associated with atypical antipsychotics were solely the effect of medications or whether they might be a feature of the illness (or psychosis) itself. METHOD We collected 24-hour ECGs on 19 patients and 24 controls. Of the patients, 9 were medication free and 10 were on atypical antipsychotics. All subject groups were matched for age and gender. Patient groups showed equivalent symptom severity and type, as well as duration of illness. We analyzed the data using nonlinear complexity (symbolic dynamic) HRV analyses as well as standard and relative spectral analyses. RESULTS For the medication-free patients as compared to the healthy controls, our data show decreased R-R intervals during sleep, and abnormal suppression of all frequency ranges, but particularly the low frequency range, which persisted even after adjusting the spectral data for the mean R-R interval. This effect was exacerbated for patients on atypical antipsychotics. Likewise, nonlinear complexity analysis showed significantly impaired HRV for medication-free patients that was exacerbated in the patients on atypical antipsychotics. CONCLUSIONS Altogether, the data suggest a pattern of significantly decreased cardiac vagal function of patients with schizophrenia as compared to healthy controls, apart from and beyond any differences due to medication side effects. The data additionally confirm earlier reports of a deleterious effect of atypical antipsychotics on HRV, which may exacerbate an underlying vulnerability in patients. These results support previous evidence that autonomic abnormalities may be a core feature of the illness (or psychosis), and that an even more conservative approach to cardiac risk in schizophrenia than previously thought may therefore be clinically appropriate.
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Affiliation(s)
- L R Mujica-Parodi
- Department of Biomedical Engineering, School of Medicine at the State University of New York, Stony Brook, NY 11794, USA.
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