Emerging Excitatory Role of Cardiovascular Sympathetic Afferents in Pathophysiological Conditions

There is sound experimental evidence that cardiovascular sympathetic afferent fibers mediate cardiovascular reflexes largely excitatory in nature with positive-feedback characteristics. This afferent neural channel is likely to normally participate in the neural regulation of cardiovascular function. The hypothesis, which is the core of this article, is that in some pathophysiological conditions, sympathetic overactivity may be partly due to an emerging excitatory reflex action of cardiovascular sympathetic afferents. In fact, the early phase of congestive heart failure can be characterized by an increase in arterial pressure and heart rate and/or by a diastolic dysfunction, leaving unchanged the cardiac output; in these conditions, in which no baroreceptor deactivation should occur, it is possible that cardiovascular sympathetic afferents with sensory endings in the thoracic low-pressure areas, highly responsive to volume loading, are responsible for mediating the reflex sympathetic excitation. Similarly, during acute myocardial infarction, ventricular sympathetic afferents are likely to mediate a reflex sympathetic overactivity, which is known to facilitate sudden death. Finally, numerous reports have described in essential arterial hypertension an increased sympathetic activity that may be due, at least in part, to the reinforcing action of sympathosympathetic reflexes. Thus, in pathophysiological conditions, cardiovascular sympathetic afferents would mediate a reflex sympathetic overactivity independently of baroreceptive mechanisms, and such an absence of a homeostatic purpose would provide a better rationale for some beneficial effects of therapeutic correction

Origin of Heart Rate Variability and Turbulence: An Appraisal of Autonomic Modulation of Cardiovascular Function

Heart period constantly changes on a beat to beat basis, due to autonomic influences on the sinoatrial node, and changes can be quantified as heart rate variability (HRV). In addition, after a premature ventricular beat, there are reproducible variations in RR interval, also due to baroreflex mediated autonomic influences on the sinoatrial node, that can be measured as heart rate turbulence (HRT). Impaired autonomic function as measured by HRV and HRT has proven to predict adverse outcomes in clinical settings. The ability of reduced HRV and HRT to predict adverse outcomes has been explained by their dependency on vagal mechanisms that could reflect an increased sympathetic and a reduced vagal modulation of sinus node, thus favoring cardiac electrical instability. Analysis of non-linear dynamics of HRV has also been utilized to describe the fractal like characteristic of the variability signal and proven effective in identify patients at risk for sudden cardiac death. Despite the clinical validity of these measures, it has also been evident that the relationship between neural input and sinus node responsiveness is extremely complex and variable in different clinical conditions. Thus, abnormal HRV or HRT on a clinical Holter recordings may reflect non-neural as well as autonomic mechanisms, and this also needs to be taken into account when interpreting any findings. However, under controlled conditions, the computation of the low and high frequency components of HRV and of their normalized powers or ratio seems capable of providing valid information on sympatho-vagal balance in normal subjects, as well as in most patients with a preserved left ventricular function. Thus, analysis of HRV does provide a unique tool to specifically assess autonomic control mechanisms in association with various perturbations. In conclusion, HRV measures are of substantial utility to identify patients with an increased cardiac mortality and to evaluate autonomic control mechanisms, but their ability to capture specific levels of autonomic control may be limited to controlled laboratory studies in relatively healthy subjects

Chronic fatigue syndrome: A hypothesis focusing on the autonomic nervous system

Chronic fatigue syndrome is a debilitating illness of unknown aetiology, with estimated levels of prevalence of up to about 8.7/100,000 in the U.S.A. Like pain fatigue it is a personal, emotionally rich experience, which may originate from peripheral or central sites (or both). The nature of the symptoms is complex and reflects the interaction of the patient with the environment and cultural milieu. Accordingly the common use of the same terminology for different types of fatigue may be misleading. Autonomic activation is a key component of both real and simulated physical exercise. Alterations in autonomic nervous system activity are a key component of several physiopathological conditions. In chronic fatigue syndrome disturbances in autonomic activity, and in other homoeostatic mechanisms, such as the hormonal and immune systems, have been reported recently. In this review we followed the hypothesis that in chronic fatigue syndrome the paradoxical condition of disturbing somatic symptoms in the absence of organic evidence of disease might be addressed by focusing on attending functional correlates. In particular we addressed possible alterations in cardiovascular autonomic control, as can be assessed by spectral analysis of R-R interval and systolic arterial pressure variability. With this approach, in subjects complaining of unexplained fatigue, we obtained data suggesting a condition of prevailing sympathetic modulation of the sino-atrial node at rest, and reduced responsiveness to excitatory stimuli. Far from considering the issue resolved, we propose that in the context of the multiple physiological and psychological interactions involved in the perception and self-reporting of symptoms, attendant changes in physiological equivalents might furnish a convenient assessment independent from subjective components. Indices of sympathetic modulation could, accordingly, provide quantifiable signs of the interaction between subject's efforts and environmental demands, independently of self descriptions, which could provide convenient measurable outcomes, both for diagnosis and treatment titration in chronic fatigue syndrome

O efeito da indução miofascial suboccipital no sistema nervoso autónomo

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em FisioterapiaIntrodução: Com a prática baseada na evidência a ser cada vez mais valorizada é premente comprovar a eficácia das técnicas manuais.A modulação do sistema nervoso autónomo (SNA) é cada vez mais importante na prevenção/tratamento de doenças pela manutenção/restabelecimento da homeostasia corporal.Objectivo:Averiguar qual o efeito das técnicas miofasciais no SNA.Métodos:Foram avaliadas as variáveis da variabilidade da frequência cardíaca (VFC) e a pressão arterial (PA) de 30 indivíduos (idade média=23,50±4,02 anos),utilizando um protocolo onde os indivíduos deveriam respirar a um ritmo de 15cpm, durante 15 minutos sendo realizada no grupo experimental(GE) a indução miofascial suboccipital nos 5 minutos intermédios.Resultados:Com a aplicação da técnica obteve-se um aumento do RMSSD e diminuição da frequência cardíaca média no GE, ainda que se verifique uma leve tendência para aumento SDNN, pNN50, HF e diminuição da razão LF/HF.Houve também uma diminuição da PA Sistólica (PAS).Conclusão:As técnicas miofasciais causam o aumento da actividade do sistema nervoso parassimpático(SNP), podendo ser úteis em diversas áreas desde a prevenção de doenças cardiovasculares à intervenção em geriatria/desporto. prove the effect of manual techniques.Autonomous nervous system (ANS) modulation takes its place as a tool for diseases’ treatment and prevention by maintenance/reestablishment of body homeostasis.Aim:Understand the effect of myofascial techniques on ANS.Methods: Heart rate and blood pressure data from 30 subjects (mean age=23,50±4,02 years-old) were evaluated,using a protocol were they should breath at a pre-determinate rate (15cpm), during 15 minutes.In the experimental group (EG) the technique (suboccipital induction) was performed on the 5 central minutes.Results:With the application of the technique in the EG there was a significant increase of RMSSD and decrease on average HR,with a light tendency to increased SDNN,pNN50,HF and decreased LF/HF ratio.It was also visible a decrease in Systolic BP.Conclusion:Myofascial techniques caused an increase in parasympathetic nervous system,being therefor useful in several areas since heart disease prevention to geriatric/sports intervention

Comparing low frequency heart rate variability and preejection period: Two sides of a different coin.

It has been hypothesized that the ratio of heart rate variability in the low- (LF) and high- (HF) frequency bands may capture variation in cardiac sympathetic control. Here we tested the temporal stability of the LF/HF ratio in 24-h ambulatory recordings and compared this ratio to the preejection period (PEP), an established measure of cardiac sympathetic control. Good temporal stability was found across a period of 3.3 years (.46<r<.78), but the LF/HF ratio did not show the expected negative correlation to PEP, either between or within subjects. We conclude that the evidence to support the LF/HF ratio as a potential marker of cardiac sympathetic control in epidemiology-scaled research is currently insufficient. Copyright © 2008 Society for Psychophysiological Research

Reliability of wavelet analysis of heart rate variability during rest and exercise

The reliability of wavelet analysis (DWT), of heart rate variability during rest and exercise was examined for this study. All twenty-three participants visited the lab on two separate occasions no less than four weeks apart. All twenty-three participants were subjected to the spontaneous breathing (SB1), and HG60 exercise condition. Of those twenty-three participants, nine performed the HG20 exercise condition as well. It was found that during the SB1 condition, the R-R intervals were fairly reliable between days. However, the reliability of all the HRV parameters (SDNN, spectral components and wavelet components) were quite poor. Interestingly, however, during HG20, the reliability of the HRV parameters was much more promising. The ability of DWT to detect changes in sympathovagal balance with incremental handgrip exercise was seen, despite a very low number of participants

Circadian rhythm of autonomic activity in non diabetic offsprings of type 2 diabetic patients

The aim of the present study was to evaluate, by heart rate variability (HRV) with 24-hours ECG Holter (HRV), the circadian autonomic activity in offspring of type 2 diabetic subjects and the relation with insulin-resistance. METHODS: 50 Caucasian offsprings of type 2 diabetic subjects were divided in two groups: insulin-resistant offsprings (IR) and non insulin-resistant offsprings (NIR). Autonomic nervous activity was studied by HRV. Time domain and spectral analysis (low frequency, LF, and high frequency, HF, provide markers of sympathetic and parasympathetic modulation when assessed in normalized units) were evaluated. RESULTS. Time domain showed a reduction of total SDNN in IR (p < 0.001) and NIR (p 0.047) versus controls. Spectral analysis showed a total and night LF higher in IR and NIR than in control group (all p < 0.001). CONCLUSION. In frequency domain, the analysis of sympathetic (LF) and parasympathetic (HF) component evidenced an association between the offspring of type 2 diabetic subjects and a sympathetic overactivity. A global reduction and alteration of circadian rhythm of autonomic activity are present in offspring of type 2 diabetic patients with and without insulin resistance. The data of our study suggested that an autonomic impairment is associated with the familiarity for type 2 diabetes independently to insulin resistance and that an impairment of autonomic system activity could precede the insulin resistance

Influence of gravitational sympathetic stimulation on the surgical plethysmographic index

Surgical Plethysmographic Index (SPI), calculated from pulse photo-plethysmographic amplitude oscillations, has been proposed as a tool to measure nociception anti-nociception balance during general anesthesia, but it is affected by several confounding factor that alter the autonomic nervous system (ANS) modulation. We hypothesized that SPI may be mainly affected by sympathetic stimulation independently from nociception. We studied the effects of two sympathetic stimuli on SPI, delivered through passive head-up tilt at 45 and 90 degrees angles, in nine awake healthy adults. The sympathetic modulation was assessed by means of heart rate variability (HRV) analysis. Mean (SD) SPI significantly increased from baseline to 45 degrees [from 38.6 (13.7) to 60.8 (7.6), p<0.001)] and to 90 degrees angle tilt [82.3 (5.4), p<0.001]. The electrocardiographic mean R-to-R interval significantly shortened during both passive tilts, whereas systolic arterial pressure did not change during the study protocol. HRV changed significantly during the study protocol towards a predominance of sympathetic modulation during passive tilt. Gravitational sympathetic stimulation at two increasing angles, in absence of any painful stimuli, affects SPI in awake healthy volunteers. SPI seems to reflect the sympathetic outflow directed to peripheral vessels

Is the algorithm used to process heart rate variability data clinically relevant? Analysis in male adolescents

OBJECTIVE: To analyze whether the algorithm used for the heart rate variability assessment (fast Fourier transform versus autoregressive methods) influenced its association with cardiovascular risk factors in male adolescents. METHODS: This cross-sectional study included 1,152 male adolescents (aged 14 to 19 years). The low frequency, high frequency components (absolute numbers and normalized units), low frequency/high frequency ratio, and total power of heart rate variability parameters were obtained using the fast Fourier transform and autoregressive methods, while the adolescents were resting in a supine position. RESULTS: All heart rate variability parameters calculated from both methods were different (p<0.05). However, a low effect size (<0.1) was found for all parameters. The intra-class correlation between methods ranged from 0.96 to 0.99, whereas the variation coefficient ranged from 7.4 to 14.8%. Furthermore, waist circumference was negatively associated with high frequency, and positively associated with low frequency and sympatovagal balance (p<0.001 for both fast Fourier transform and autoregressive methods in all associations). Systolic blood pressure was negatively associated with total power and high frequency, whereas it was positively associated with low frequency and sympatovagal balance (p<0.001 for both fast Fourier transform and autoregressive methods in all associations). Body mass index was negatively associated with high frequency, while it was positively associated with low frequency and sympatovagal balance (p values ranged from <0.001 to 0.007). CONCLUSION: There are significant differences in heart rate variability parameters obtained with the fast Fourier transform and autoregressive methods in male adolescent; however, these differences are not clinically significant. OBJETIVO: Analisar se o algoritmo usado para avaliação da variabilidade da frequência cardíaca (transformada rápida de Fourier versus autoregressivo) influencia em sua associação com fatores de risco cardiovascular adolescentes do gênero masculino. MÉTODOS: Estudo transversal, que incluiu 1.152 adolescentes do gênero masculino (14 a 19 anos). Componentes de baixa e alta frequência (absolutos e unidades normalizadas), razão componente de baixa frequência/componente de alta frequência e poder total da variabilidade da frequência cardíaca foram obtidos em repouso, na posição supina, usando os métodos transformada rápida de Fourier e autorregressivo. RESULTADOS: Todos os parâmetros da variabilidade da frequência cardíaca para ambos os métodos foram diferentes (p<0,05). Entretanto, um pequeno tamanho do efeito (<0,1) foi observado para todos os parâmetros. Os coeficientes de correlação intraclasse entre os métodos variaram de 0,96 a 0,99, enquanto os coeficientes de variação foram de 7,4 a 14,8%. A circunferência abdominal foi negativamente associada com o componente de alta frequência, e positivamente associada com o componente de baixa frequência e o balanço simpatovagal (p<0,001 para a transformada rápida de Fourier e o autorregressivo em todas as associações). A pressão arterial sistólica foi negativamente associada com o poder total e o componente de alta frequência, enquanto foi positivamente associada com o componente de baixa frequência e o balanço simpatovagal (p<0,001 para a transformada rápida de Fourier e o autorregressivo em todas as associações). O índice de massa corporal foi negativamente associado com o componente de alta frequência, enquanto foi positivamente associado com o componente de baixa frequência e o balanço simpatovagal (valores de p variando de <0,001 a 0,007). CONCLUSÃO: Houve diferenças significantes nos parâmetros da variabilidade da frequência cardíaca obtidos com os métodos transformada rápida de Fourier e autorregressivo em adolescentes masculinos, mas essas diferenças não foram clinicamente significativas

Prolonged decrease in heart rate variability after elective hip arthroplasty

The pattern of postoperative heart rate variability may provide insight into the response of the autonomic nervous system to anaesthesia and surgery. We have obtained spectral (fast Fourier transform) and non-spectral indices of heart rate variability from electrocardiographic recordings, sampled during continuous perioperative Holter monitoring in 15 otherwise healthy patients with an uncomplicated postoperative course, undergoing elective hip arthroplasty with either spinal or general anaesthesia. In both groups, total spectral energy (0.01-1 Hz), low-frequency spectral energy (0.01-0.15 Hz) and high-frequency spectral energy (0.15-0.40 Hz) decreased after surgery to 32% (95% confidence interval (Cl) 10.5; P <0.01), 29% (95% Cl 12.5; P <0.07; and 33% (95% Cl 12.5; P <0.01) of their preoperative values, respectively, and these indices remained suppressed for up to 5 days. Non-spectral indices decreased to a similar extent. These findings indicate a substantial and prolonged postoperative decrease in both parasympathetic and sympathetic influence on the sinus nod