Clinical Autonomic Research最新文献

{"title":"Determinants of carotid sinus hypersensitivity in patients with suspected reflex syncope.","authors":"Michele Brignole, J Gert van Dijk, Artur Fedorowski, Frederik J De Lange","doi":"10.1007/s10286-026-01209-0","DOIUrl":"10.1007/s10286-026-01209-0","url":null,"abstract":"<p><strong>Purpose: </strong>To elucidate the pathophysiology of the carotid sinus reflex in a large cohort of patients with suspected reflex syncope.</p><p><strong>Method: </strong>We reviewed an electronic database of patients with suspected reflex syncope who underwent carotid sinus massage. The diagnostic protocol included both right and left massage, in supine and upright positions, followed by tilt testing.</p><p><strong>Results: </strong>The cohort included 2249 patients (52% male), median age 73 years. The conventional abnormality threshold of a maximum RR interval ≥ 3000 ms was present in 14.7% of patients and of a systolic blood pressure fall > 50 mmHg in 14.3% of patients. Abnormal responses occurred more frequently on the right side than the left side, and more during upright than supine testing. A second abnormal test occurred more often ipsilaterally. The extent of the maximum RR interval elicited by massage was independent of the baseline RR interval, whereas the difference in systolic blood pressure fall increased markedly with higher baseline values. The occurrence and severity of cardioinhibition and vasodepression increased with age, beginning at 40 years. Abnormal RR intervals and blood pressure drops were observed more frequently in men than in women. Additionally, there was only a limited correlation between positive responses to carotid massage and tilt testing concerning asystole and blood pressure reduction.</p><p><strong>Conclusion: </strong>Age, sex and initial systolic blood pressure strongly influence response to carotid sinus massage. Abnormal responses did not correlate with positive tilt test results, possibly as a result of opposing effects of age and sex on carotid sinus hypersensitivity and vasovagal syncope.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"499-511"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthostatic hypotension and complaints: not a clear-cut relation.","authors":"Boriana S Gagaouzova, Ineke A van Rossum, Fabian I Kerkhof, Roland D Thijs, J Gert van Dijk","doi":"10.1007/s10286-026-01222-3","DOIUrl":"10.1007/s10286-026-01222-3","url":null,"abstract":"<p><strong>Purpose: </strong>Previous research regarding the association between blood pressure (BP) fall and symptoms yielded inconsistent results in classical orthostatic hypotension (cOH), with some studies proposing specific cut-off values and others reporting only weak or absent correlations. This study examined clinical cOH symptoms in relation to changes in BP and the haemodynamic parameters determining BP.</p><p><strong>Methods: </strong>We retrospectively analysed 77 tilt test records showing cOH and selected 40 with and 37 without complaint recognition during the test. We compared absolute values of haemodynamic parameters as well as the differences and ratios compared to supine baseline at three different times during tilt. We also explored relationships between relative haemodynamic changes and symptoms with the log-ratio method.</p><p><strong>Results: </strong>There was a larger blood pressure fall in the group with complaint recognition compared (49.2 vs 37.3, p = 0.043). The log-ratio analysis showed less total peripheral resistance increase and a larger blood pressure decrease in the symptomatic group.</p><p><strong>Conclusion: </strong>Recognised complaints were related to a larger BP fall, while in previous studies complaints were either not related to BP or to minimum BP. These contrasts suggest that the pathophysiology of orthostatic complaints is complex. The chain of events from low BP to awareness of complaints contains multiple links, of which cerebral perfusion is probably a critical one. We suggest that the pathway contains so much variability that we should not expect the relation between low blood pressure and complaints in cOH to be simple.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"467-475"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproducibility of orthostatic blood pressure measurements in a middle-aged population-based cohort: a one-year follow-up study.","authors":"Christian Zambach, Sofia Gerward, Steven van Zanten, Frederik J de Lange, Artur Fedorowski, Gunnar Engström, Viktor Hamrefors","doi":"10.1007/s10286-026-01205-4","DOIUrl":"10.1007/s10286-026-01205-4","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"541-544"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adrenocortical response during HUT test in patients with vasovagal syncope.","authors":"Barbora Pavlovič Bačkorová, Zora Lazúrová, Monika Lukáčová, Kristína Valová, Peter Mitro, Ivica Lazúrová","doi":"10.1007/s10286-026-01203-6","DOIUrl":"10.1007/s10286-026-01203-6","url":null,"abstract":"<p><strong>Purpose: </strong>This prospective observational study was carried out to evaluate the response of adrenocortical hormones (cortisol and aldosterone) to head-up tilt (HUT)-induced vasovagal syncope in relation to hemodynamic changes.</p><p><strong>Subjects and methods: </strong>Blood samples from 79 patients (48 women and 31 men, age 19-73 years) who underwent the HUT test were analyzed for serum aldosterone and cortisol. On the basis of their response, patients were categorized into two groups: 50 HUT-positive (HUT+) and 29 HUT-negative (HUT-) patients.</p><p><strong>Results: </strong>HUT+ patients exhibited significantly lower baseline aldosterone levels compared with HUT- patients (203.1 ± 78.8 versus 266.2 ± 76.3 pg/ml, p = 0.0009). Similarly, aldosterone levels after the HUT test were lower in the HUT+ as compared with the HUT- group (249.5 ± 101.3 versus 351.4 ± 98.11 pg/ml, p < 0.0001). However, serum cortisol showed no significant differences between groups. Aldosterone increased in response to HUT in both groups. Aldosterone positively correlated with systolic and diastolic blood pressure, as well as heart rate. Integration of aldosterone with clinical assessment and additional laboratory tests may improve diagnostic accuracy and risk stratification.</p><p><strong>Conclusions: </strong>The results demonstrate significantly lower serum aldosterone concentrations in HUT+ patients at baseline and after HUT test in comparison with HUT- patients. Moreover, aldosterone levels positively correlated with systolic and diastolic blood pressure (BP). However, serum cortisol levels did not discriminate HUT+ from HUT- patients.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"477-484"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147479901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of hyperadrenergic orthostatic hypotension.","authors":"Robert A Castro, Pouya E Mehr, Patricio Millar Vernetti, Naome Mwesigwa, Italo Biaggioni, Satish R Raj, Esraa Shehata, Amber J Hackstadt, Tan Ding, Horacio Kaufmann, Cyndya A Shibao","doi":"10.1007/s10286-026-01211-6","DOIUrl":"10.1007/s10286-026-01211-6","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"545-548"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147947840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular pharmacology of dopaminergic agents in humans: a review.","authors":"Jose-Alberto Palma, Jose G Gomez Casanovas","doi":"10.1007/s10286-026-01229-w","DOIUrl":"10.1007/s10286-026-01229-w","url":null,"abstract":"<p><strong>Purpose: </strong>To review the cardiovascular effects of pharmacologic dopamine receptor modulation in humans, organized by receptor subtype.</p><p><strong>Methods: </strong>Narrative review of human pharmacological, genetic, and clinical evidence linking dopamine receptor agonism and antagonism to blood pressure and heart rate changes in healthy volunteers and in patients with Parkinson disease, autonomic failure, psychiatric disorders, and selected cardiovascular conditions.</p><p><strong>Results: </strong>Dopaminergic receptor agonism generally lowers blood pressure, with the magnitude of hypotension tracking with intrinsic activity: full orthosteric agonists (bromocriptine, ropirinole, apomorphine) carry the highest risk of orthostatic hypotension, and partial agonists (tavapadon) produce attenuated but clinically relevant hypotension. Dopamine D3-preferring agents (PF-592379, mesdopetam, cariprazine) have neutral cardiovascular effects in short-term trials. Levodopa-induced orthostatic hypotension arises from at least five converging mechanisms whose clinical impact is amplified by underlying neurogenic orthostatic hypotension. A notable exception is mevidalen, a centrally acting dopamine D1 positive allosteric modulator that paradoxically raises blood pressure. Despite murine knockout models consistently predicting that dopamine receptor deletion produces hypertension, pharmacological antagonism in humans does not reliably raise blood pressure: dopamine D1, D2, and D3 antagonists show largely neutral cardiovascular profiles, while antipsychotic-associated orthostatic hypotension is driven primarily by α1-adrenergic blockade.</p><p><strong>Conclusions: </strong>The cardiovascular response to dopaminergic agents depends on receptor selectivity, intrinsic activity, and baroreflex integrity. The discrepancy between murine-knockout-predicted hypertension and human pharmacological neutrality with antagonists, and the hypertensive effects of dopamine D1 positive allosteric modulators, represent key unresolved questions.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"427-443"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indications, contraindications, and step-by-step methodology for performing carotid sinus massage in patients presenting with syncope : A scientific statement of an Ad Hoc Syncope Consortium endorsed by: the European Autonomic Society (EFAS), Gruppo Italiano Multidisciplinare Syncope (GIMSI) and European Geriatric Medicine Society (EuGMS).","authors":"Frederik J de Lange, Michele Brignole, David G Benditt, Melani Dani, Jean Claude Deharo, Alessandra Fanciulli, Artur Fedorowski, Antonella Groppelli, Mohamed H Hamdan, Viktor Hamrefors, Jelle S Y de Jong, Rose Anne Kenny, Piotr Kulakowski, Angel Moya, Roberto Maggi, Carlos A Morillo, Brian Olshansky, Satish R Raj, Ciara Rice, Giulia Rivasi, Ineke van Rossum, Vincenzo Russo, Robert Sheldon, Win-Kuan Shen, Richard Sutton, Roland Thijs, Patricia Taraborrelli, Marco Tomaino, Andrea Ungar, Steven van Zanten","doi":"10.1007/s10286-026-01218-z","DOIUrl":"10.1007/s10286-026-01218-z","url":null,"abstract":"<p><p>Carotid sinus massage (CSM) is essential in evaluating recurrent unexplained reflex syncope, as it uniquely identifies cardioinhibitory forms that other tests may miss. CSM is largely underused in clinical practice outside dedicated syncope facilities and, when performed, its execution varies, as does the interpretation of results. Underuse affects the diagnostic yield of CSM in the syncope evaluation, thereby denying patients mechanism-based personalized treatment. There are several barriers to the proper use of CSM in the work-up of patients with unexplained syncope.To address these important limitations, an international panel of experts in the field of syncope provide herein a consensus document with the aim of offering practical guidance for the indications, contraindications, and methodology for performing carotid sinus massage in general and dedicated syncope facilities and in the emergency department.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"485-497"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between cerebral white matter hyperintensities and autonomic function in older individuals with cerebral small vessel disease.","authors":"Yanna Li, Yajing Wang, Shoufeng Liu, Yilin Ma, Jialing Wu","doi":"10.1007/s10286-026-01221-4","DOIUrl":"10.1007/s10286-026-01221-4","url":null,"abstract":"<p><strong>Purpose: </strong>Heart rate variability (HRV) has been linked to cerebral small vessel disease (CSVD) development. This study aimed to investigate the relationship between white matter hyperintensity (WMH) and HRV in older patients with CSVD.</p><p><strong>Methods: </strong>Patients with CSVD aged ≥ 60 years, diagnosed via magnetic resonance imaging and treated at Tianjin Huanhu Hospital in October 2022-April 2023, were included. WMH burden was defined as periventricular (PV-WMH) or deep WMH (D-WMH), with Fazekas scores of 3 or 2-3, respectively. Modified WMH burden was categorized based on total Fazekas scores (PV-WMH + D-WMH): grade 0 for 0-2, grade 1 for 3-4, and grade 2 for 5-6. Patient demographics were documented, and HRV was analyzed through 10-min short-range electrocardiography recordings. Time-domain indices included standard deviation of N-N intervals, root-mean-squared differences of successive N-N intervals, and the proportion of N-N intervals exceeding 50 ms. Frequency-domain indices included low-frequency power (LF, 0.04-0.15 Hz), high-frequency power (HF, 0.15-0.4 Hz), and LF/HF. Correlations were examined using univariable and multivariable analyses.</p><p><strong>Results: </strong>Among 108 patients with CSVD (age 60-87 years; median 66.0 years [interquartile range 63.0-71.0]), WMH burden was associated with sex, age, stroke, LF, and LF/HF (p < 0.05), with LF/HF independently linked in multivariable analysis. Modified WMH burden showed similar associations and remained independently correlated with LF/HF (p < 0.05).</p><p><strong>Conclusions: </strong>The presence and severity of WMH in CSVD were related to decreased LF/HF. This is possibly due to decreased cardiac sympathetic activity, indicates that decreased LF/HF may be a potential risk factor for WMH, and can be detected via short HRV recordings.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"513-521"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sigmoid volvulus, acute colonic pseudo-obstruction, and chronic megacolon in Parkinson disease.","authors":"John A Damianos, Kara J Jencks, Wolfgang Singer, Kristina Matkowskyj, Robert R Cima, Michael Camilleri","doi":"10.1007/s10286-026-01219-y","DOIUrl":"10.1007/s10286-026-01219-y","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"525-529"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vagus nerve stimulation and pulmonary outcomes: a scoping review of preclinical and clinical evidence.","authors":"Miray Başer, Betül Taşpınar, Ferruh Taşpınar","doi":"10.1007/s10286-026-01228-x","DOIUrl":"10.1007/s10286-026-01228-x","url":null,"abstract":"<p><strong>Background: </strong>Vagus nerve stimulation (VNS) is a neuromodulatory intervention with antiinflammatory and autonomic regulatory properties. Although its clinical applications have primarily been explored in neurological disorders, its potential role in pulmonary and respiratory outcomes across preclinical and clinical settings remains incompletely characterized and dispersed across different study domains. This scoping review aimed to map the available evidence on the effects of VNS on the pulmonary and respiratory systems, with particular emphasis on inflammatory and autonomic mechanisms.</p><p><strong>Methods: </strong>This scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Three reviewers systematically searched PubMed, Web of Science, and the Cochrane Library for studies published between January 2020 and February 2026. Original preclinical and clinical studies investigating invasive or noninvasive VNS and reporting pulmonary, respiratory physiology, autonomic, or inflammatory outcomes were included.</p><p><strong>Results: </strong>A total of 159 records were identified, of which 12 studies met the inclusion criteria. The evidence base was predominantly preclinical. In animal studies, invasive cervical VNS was frequently associated with reductions in pulmonary inflammation, histopathological lung injury, and proinflammatory cytokine expression. Clinical studies were limited and heterogeneous, but generally indicated variable modulation of autonomic function, including changes in parasympathetic activity, as well as heterogeneous effects on systemic inflammatory markers and limited respiratory outcomes.</p><p><strong>Conclusions: </strong>Current evidence suggests that VNS may modulate pulmonary inflammatory responses in preclinical models. However, clinical evidence remains limited and heterogeneous, particularly regarding autonomic and respiratory outcomes. Well-designed clinical trials using standardized stimulation protocols and predefined respiratory end points are needed to clarify its therapeutic potential in respiratory disorders.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"457-466"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}