Neuromodulation in heart failure

The prognosis of heart failure with reduced ejection fraction remains poor. Neurohumoral activation, including increased cardiac sympathetic nerve activity, plays an important role in the pathogenesis as well as disease progression. Recently, several neuromodulation strategies have been proposed that aim to directly affect the residual autonomic imbalance. Spinal cord stimulation is one of the proposed methods. In the clinical part of this project, we assessed the mid-term effect of spinal cord stimulation on cardiac sympathetic nerve activity and the acute effect on autonomic balance. In the total study population, we did not detect any changes in cardiac sympathetic nerve activity or heart rate variability. However, we observed that the patients with high baseline sympathetic nerve activity or low heart rate variability responded favourably to therapy, reflected in reduced cardiac sympathetic nerve activity and increased heart rate variability. Considering these results, we conducted an experimental study focused on the effect of acute severe heart failure on heart rate variability. In a porcine model of hypoxic myocardial dysfunction, we observed a significant reduction in heart rate variability in all parameters recorded. Our results indicate that spinal cord stimulation may improve autonomic...Srdeční selhání se sníženou ejekční frakcí je přes veškeré pokroky v léčbě stále spojeno s velmi špatnou prognózou. Předpokládá se, že v patogenezi tohoto onemocnění se významně uplatňuje neurohumorální aktivace, zahrnující i zvýšenou aktivitu sympatického nervového systému. Bylo proto navrženo několik postupů tzv. neuromodulační léčby, která má za cíl přímým zásahem do vegetativního nervového systému příznivě ovlivnit reziduální autonomní nerovnováhu. Jednou z nadějných metod neuromodulace je míšní stimulace. V klinické části práce jsme proto u pacientů se srdečním selháním posuzovali vliv míšní stimulace na sympatickou nervovou aktivitu srdce a autonomní rovnováhu. V celé sledované populaci jsme neprokázali střednědobý vliv míšní stimulace na srdeční sympatickou nervovou aktivitu, ani akutní vliv na variabilitu srdeční frekvence. Pacienti se vstupně vyšší sympatickou nervovou aktivitou nebo nízkou variabilitou srdeční frekvence však na léčbu míšní stimulací reagovali příznivě. Došlo u nich k poklesu sympatické nervové aktivity srdce a ke zvýšení variability srdeční frekvence. S ohledem na tato pozorování jsme uspořádali experimentální studii s cílem zjistit, jak variabilitu srdeční frekvence ovlivní těžké akutní srdeční selhání. Na modelu akutně navozené hypoxické dysfunkce myokardu u prasete...external workplacesexterní pracoviště1. lékařská fakultaFirst Faculty of Medicin

Neuromodulation in heart failure

The prognosis of heart failure with reduced ejection fraction remains poor. Neurohumoral activation, including increased cardiac sympathetic nerve activity, plays an important role in the pathogenesis as well as disease progression. Recently, several neuromodulation strategies have been proposed that aim to directly affect the residual autonomic imbalance. Spinal cord stimulation is one of the proposed methods. In the clinical part of this project, we assessed the mid-term effect of spinal cord stimulation on cardiac sympathetic nerve activity and the acute effect on autonomic balance. In the total study population, we did not detect any changes in cardiac sympathetic nerve activity or heart rate variability. However, we observed that the patients with high baseline sympathetic nerve activity or low heart rate variability responded favourably to therapy, reflected in reduced cardiac sympathetic nerve activity and increased heart rate variability. Considering these results, we conducted an experimental study focused on the effect of acute severe heart failure on heart rate variability. In a porcine model of hypoxic myocardial dysfunction, we observed a significant reduction in heart rate variability in all parameters recorded. Our results indicate that spinal cord stimulation may improve autonomic..

A Total of 207 Days of Veno-Venous Extracorporeal Membrane Oxygenation Support for Severe COVID-19 Prior to Successful Lung Transplantation: A Case Report

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a life-saving treatment for respiratory failure that may serve as a bridge to patient recovery or lung transplantation. In COVID-19, recovery is somewhat unpredictable and occasionally occurs after >100 days on VV-ECMO support. Thus, determining therapy cessation may be difficult. We report the case of a 59-year-old male without specific risk factors admitted to a tertiary center for rapidly progressive respiratory failure due to severe COVID-19, despite aggressive mechanical ventilatory support. Immediate insertion of VV-ECMO was associated with prompt resolution of hypoxemia and hypercapnia; however, all therapeutic efforts to wean the patient from VV-ECMO failed. During the prolonged hospitalization on VV-ECMO, sepsis was the most life-threatening complication. The patient overcame roughly 40 superinfections, predominantly affecting the respiratory tract, and spent 183 days on antimicrobial treatment. Although the function of other organ systems was generally stable, gradually progressive right ventricular dysfunction due to precapillary pulmonary hypertension required increasing doses of inotropes. A successful lung transplantation was performed after 207 days of VV-ECMO support. The present case provides evidence for prolonged VV-ECMO therapy as a bridge to lung transplantation in severe COVID-19 despite numerous, predominantly infectious complications

Acute Severe Heart Failure Reduces Heart Rate Variability: An Experimental Study in a Porcine Model

There are substantial differences in autonomic nervous system activation among heart (cardiac) failure (CF) patients. The effect of acute CF on autonomic function has not been well explored. The aim of our study was to assess the effect of experimental acute CF on heart rate variability (HRV). Twenty-four female pigs with a mean body weight of 45 kg were used. Acute severe CF was induced by global myocardial hypoxia. In each subject, two 5-min electrocardiogram segments were analyzed and compared: before the induction of myocardial hypoxia and >60 min after the development of severe CF. HRV was assessed by time-domain, frequency-domain and nonlinear analytic methods. The induction of acute CF led to a significant decrease in cardiac output, left ventricular ejection fraction and an increase in heart rate. The development of acute CF was associated with a significant reduction in the standard deviation of intervals between normal beats (50.8 [20.5–88.1] ms versus 5.9 [2.4–11.7] ms, p < 0.001). Uniform HRV reduction was also observed in other time-domain and major nonlinear analytic methods. Similarly, frequency-domain HRV parameters were significantly changed. Acute severe CF induced by global myocardial hypoxia is associated with a significant reduction in HRV

Relationele diversiteit en subjectief welzijn in het hedendaagse België: een onderzoek naar onderliggende mechanismen

Bestaand internationaal onderzoek toont aan dat de relatiestatus van iemand gerelateerd is aan diens subjectief welzijn. Meer in het bijzonder komt uit studies naar boven dat gehuwden gelukkiger zijn dan individuen die single, samenwonend, of gescheiden zijn. Echter, gezien het toenemend aantal alternatieve relatie- en gezinsvormen in onze hedendaagse Belgische samenleving kan men zich afvragen of de protectieve voordelen verbonden aan het huwelijk nog zo uitgesproken zijn. In deze bijdrage bespreken wij de resultaten van een grote internet-survey die wij uitvoerden bij 4.000 volwassenen in Vlaanderen en Wallonië en die tot doel had om: a) het verband tussen relatiestatus en subjectief welzijn te onderzoeken bij individuen met uiteenlopende relatie/gezinsvormen (alleenstaand, gehuwd met/zonder kinderen, samenwonend met/zonder kinderen, alleenstaande ouder, nieuw samengesteld gezin, ….); b) de onderliggende mechanismen van dit verband te identificeren (o.a., lichamelijke gezondheid, seksuele frequentie/tevredenheid, financiële zorgen, gevoelens van discriminatie). Er wordt tevens stilgestaan bij de mogelijke klinische en praktische implicaties van de onderzoeksresultaten

Publisher Correction: Measuring the α-particle charge radius with muonic helium-4 ions

This Article was originally published online on 27 January 2021 without Open Access. With the author(s)’ decision to opt for Open Access, the copyright of the Article changed on 17 February 2021 to © The Author(s) 2021, and the Article is now licensed/distributed under the terms of a Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/.), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The original Article has been corrected online