Clinical Autonomic Research最新文献

{"title":"The role of vestibular function on the vestibulo-sympathetic reflex recovery among children following moderate to severe traumatic brain injury.","authors":"Gilad Sorek, Isabelle Gagnon, Kathryn Schneider, Mathilde Chevignard, Nurit Stern, Yahaloma Fadida, Liran Kalderon, Sharon Shaklai, Michal Katz-Leurer","doi":"10.1007/s10286-024-01067-8","DOIUrl":"10.1007/s10286-024-01067-8","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"613-617"},"PeriodicalIF":3.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342682","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":"Comment to the article titled: sympathetic dysfunction as an early indicator of autonomic involvement in Parkinson's disease.","authors":"Ilaria Cani, Pietro Guaraldi, Luisa Sambati, Pietro Cortelli, Giovanna Calandra-Buonaura","doi":"10.1007/s10286-024-01057-w","DOIUrl":"10.1007/s10286-024-01057-w","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"607-608"},"PeriodicalIF":3.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916218","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":"Unraveling the stride: exploring the influence of neurogenic orthostatic hypotension on gait and balance in Parkinson's disease.","authors":"Gabriele Imbalzano, Claudia Ledda, Marta Maria Tangari, Carlo Alberto Artusi, Elisa Montanaro, Mario Giorgio Rizzone, Maurizio Zibetti, Leonardo Lopiano, Alberto Romagnolo","doi":"10.1007/s10286-024-01071-y","DOIUrl":"10.1007/s10286-024-01071-y","url":null,"abstract":"<p><strong>Purpose: </strong>Neurogenic orthostatic hypotension (nOH) and gait impairment are frequent sources of disability in Parkinson's disease (PD). However, the impact of nOH on balance and gait features remains unclear. This cross-sectional study aimed to assess the influence of nOH on postural and gait parameters in a cohort of patients with PD by means of wearable inertial sensors.</p><p><strong>Methods: </strong>Gait and balance were assessed using Opal inertial sensors. nOH was defined as sustained systolic blood pressure (BP) drop ≥ 20 mmHg or diastolic BP drop ≥ 10 mmHg within 3 min of standing, with a ΔHR/ΔSBP ratio ≤ 0.5 bpm/mmHg. Analysis of covariance was performed to evaluate differences in gait/balance features between patients with and without nOH, adjusting for age, cognitive status, and motor disability. Moreover, we performed the same analysis considering the presence of hemodynamically relevant nOH (orthostatic mean BP ≤ 75 mmHg).</p><p><strong>Results: </strong>A total of 82 patients were enrolled, 26 with nOH (31.7%), of which 13 presented with hemodynamically relevant nOH. After correcting for confounders, nOH was independently associated with lower gait speed (p = 0.027), shorter stride length (p = 0.033), longer time for postural transitions (p = 0.004), and increased postural sway (p = 0.019). These differences were even more pronounced in patients with hemodynamically relevant nOH. Higher postural sway was associated with a 7.9-fold higher odds of falls (p = 0.040).</p><p><strong>Conclusions: </strong>Our study presents an objective demonstration of the independent negative impact of nOH on gait and balance in PD, emphasizing the need for careful detection and management of nOH to mitigate gait and balance disturbances in PD.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"593-601"},"PeriodicalIF":3.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11543729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364593","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":"The insular cortex, autonomic asymmetry and cardiovascular control: looking at the right side of stroke.","authors":"Marco Antônio Peliky Fontes, Liliane Ramos Dos Santos Machado, Ana Clara Rocha Viana, Matheus Henrique Cruz, Ícaro Santos Nogueira, Marcela Gondim Lima Oliveira, Christiane Braga Neves, Ana Caroline Ventris Godoy, Luke A Henderson, Vaughan G Macefield","doi":"10.1007/s10286-024-01066-9","DOIUrl":"10.1007/s10286-024-01066-9","url":null,"abstract":"<p><strong>Purpose: </strong>Evidence from animal and human studies demonstrates that cortical regions play a key role in autonomic modulation with a differential role for some brain regions located in the left and right brain hemispheres. Known as autonomic asymmetry, this phenomenon has been demonstrated by clinical observations, by experimental models, and currently by combined neuroimaging and direct recordings of sympathetic nerve activity. Previous studies report peculiar autonomic-mediated cardiovascular alterations following unilateral damage to the left or right insula, a multifunctional key cortical region involved in emotional processing linked to autonomic cardiovascular control and featuring asymmetric characteristics.</p><p><strong>Methods: </strong>Based on clinical studies reporting specific damage to the insular cortex, this review aims to provide an overview of the prognostic significance of unilateral (left or right hemisphere) post-insular stroke cardiac alterations. In addition, we review experimental data aiming to unravel the central mechanisms involved in post-insular stroke cardiovascular complications.</p><p><strong>Results and conclusion: </strong>Current clinical and experimental data suggest that stroke of the right insula  can present a worse cardiovascular prognosis.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"549-560"},"PeriodicalIF":3.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307226","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":"Blood volume deficit in postural orthostatic tachycardia syndrome assessed by semiautomated carbon monoxide rebreathing.","authors":"Surat Kulapatana, Vasile Urechie, Stefano Rigo, Abigail Mohr, Yuliya A Vance, Luis E Okamoto, Alfredo Gamboa, Cyndya Shibao, Italo Biaggioni, Raffaello Furlan, André Diedrich","doi":"10.1007/s10286-024-01091-8","DOIUrl":"https://doi.org/10.1007/s10286-024-01091-8","url":null,"abstract":"<p><strong>Purpose: </strong>The semiautomated carbon monoxide (CO) rebreathing method has been introduced as a noninvasive and radiation-free blood volume estimation method. We tested whether the semiautomated CO rebreathing method can detect the blood volume deficit in postural orthostatic tachycardia syndrome (POTS). In addition, we explored the relationship between blood volume estimated from CO rebreathing and body impedance.</p><p><strong>Patients and methods: </strong>We recruited 53 subjects (21 female patients with POTS, 19 healthy female participants, and 13 healthy male participants) to record blood volumes and hemodynamic data. Blood volumes were measured by CO rebreathing and segmental body impedance. Linear regression models to predict normal values of red blood cell volume (RBCV), plasma volume (PV), and total blood volume (BV) were developed. Percentage deviations from the predicted normal volumes were calculated.</p><p><strong>Results: </strong>Patients with POTS had lower RBCV (25.18 ± 3.95 versus 28.57 ± 3.68 mL/kg, p = 0.008, patients with POTS versus healthy female participants), BV (64.53 ± 10.02 versus 76.78 ± 10.00 mL/kg, p < 0.001), and BV deviation (-13.92 ± 10.38% versus -0.02 ± 10.18%, p < 0.001). Patients with POTS had higher supine heart rate (HR) (84 ± 14 versus 69 ± 11 bpm, p < 0.001) and upright HR (123 ± 23 versus 89 ± 22 bpm, p < 0.001). We found a correlation between BV deviation and upright HR in patients with POTS (r = -0.608, p = 0.003), but not in healthy participants. Volumes from the CO rebreathing and body impedance were well correlated (r = 0.629, p < 0.001).</p><p><strong>Conclusions: </strong>The CO rebreathing method can detect BV deficit, as well as the RBCV deficit in patients with POTS. The negative correlation between BV deviation and upright HR indicates that hypovolemia is one of the pathophysiological causes of POTS. Correlations between body impedance and CO rebreathing volume suggest its usefulness for measurements of volume changes.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766667","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":"Mechanical circulatory support reduces renal sympathetic nerve activity in an ovine model of acute myocardial infarction.","authors":"Tania Warnakulasuriya, Bindu George, Nigel Lever, Rohit Ramchandra","doi":"10.1007/s10286-024-01086-5","DOIUrl":"https://doi.org/10.1007/s10286-024-01086-5","url":null,"abstract":"<p><strong>Purpose: </strong>The use of circulatory assist devices has been shown to improve glomerular filtration rate and reduce the incidence of acute kidney injury in patients following acute cardiac pathology. However, the mechanisms of improvement in kidney function are not clear. We tested the hypothesis that mechanical circulatory support would result in a decrease in directly recorded renal sympathetic nerve activity (RSNA) and mediate the improvement in renal blood flow (RBF) in a setting of acute myocardial infarction (AMI)-induced left ventricular systolic dysfunction.</p><p><strong>Methods: </strong>An anaesthetized ovine model was used to induce AMI (n = 8) using injections of microspheres into the left coronary artery in one group. The second group did not undergo embolization (n = 6). The effects of mechanical circulatory support using the Impella CP on directly recorded renal sympathetic nerve activity were examined in these two groups of animals.</p><p><strong>Results: </strong>Injection of microspheres resulted in a drop in mean arterial pressure (MAP) of 21 ± 4 mmHg compared to baseline values (p < 0.05; n = 8). This was associated with a 67% increase in renal sympathetic nerve activity (RSNA; from 16 ± 5 to 21 ± 5 spikes/s; p < 0.05; n = 7). Impella CP support significantly increased MAP by 13 ± 1.5 mmHg at pump level 8 (p < 0.05) in the AMI group. Incremental pump support resulted in a significant decrease in RSNA (p < 0.05) in both groups. At pump level P8 in the AMI group, RSNA was decreased by 21 ± 5.5% compared to pump level P0 when the pump was not on.</p><p><strong>Conclusion: </strong>Our data indicate that the improvement in kidney function following mechanical circulatory support may be mediated in part by renal sympathoinhibition.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726444","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":"Can standing replace upright tilt table testing in the diagnosis of postural tachycardia syndrome (POTS) in the young?","authors":"Julian M Stewart, Marvin S Medow","doi":"10.1007/s10286-024-01080-x","DOIUrl":"https://doi.org/10.1007/s10286-024-01080-x","url":null,"abstract":"<p><strong>Purpose: </strong>We compared standing and upright tilt in patients with postural tachycardia syndrome (POTS) and healthy volunteers to determine whether standing accurately tests for POTS in youngsters < 19 years. POTS in adolescents is defined by orthostatic intolerance plus sustained excessive upright tachycardia, without hypotension during upright tilt. We examined whether active standing is a valid classifier for POTS in adolescents compared to tilt.</p><p><strong>Methods: </strong>Patients with POTS (N = 36, 12.2-18.8 years) and healthy volunteers (N = 39, 13.1-18.9 years) performed stand for a minimum of 5-min and were tilted to 70° for 10 min. Receiver operating characteristics analyses (ROC) were performed at 5-min stand, and at 5  and 10 min tilt for optimal threshold for heart rate (HR) increase (ΔHR), and test sensitivity and specificity.</p><p><strong>Results: </strong>Most subjects were unable to stand for 10 min. ΔHRs at 5 min stand were higher in POTS (31 ± 3) compared with control (21 ± 2) and elevated at 5- or 10-min tilt in POTS (51 ± 3 and 51 ± 2) versus control (26 ± 2 and 25 ± 2) compared with standing. ΔHR in POTS and controls for 10 min were not different from 5 min. For 5 min stand ROC threshold was 26 beats per min (bpm), sensitivity of 70.6%, and specificity of 68.2% compared with 39 bpm, 88.2%, and 95.1% for 5 min tilt, and 40 bpm, 94.1%, and 95.1% for 10-min tilt. A precision-recall graph confirmed the superior discriminating ability of 5 min and 10 min tilt compared to 5 min stand.</p><p><strong>Conclusions: </strong>The stand test is relatively non-specific and imprecise compared to tilt and does not satisfactorily distinguish POTS from control in patients aged < 19 years old.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726210","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":"Serotonin does not seem to play a major role in eliciting vasovagal syncope.","authors":"Paolo Alboni","doi":"10.1007/s10286-024-01092-7","DOIUrl":"https://doi.org/10.1007/s10286-024-01092-7","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680990","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":"Re: Comprehensive linear and nonlinear heart rate variability normative data in children. Clinical Autonomic Research (September 2024).","authors":"James J Joyce","doi":"10.1007/s10286-024-01088-3","DOIUrl":"https://doi.org/10.1007/s10286-024-01088-3","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680988","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":"Trends in syncope testing and admissions in the USA from 2006 through 2019.","authors":"Mohammed Ruzieh, Chen Bai, Stephen E Kimmel, Zachary D Goldberger, Osama Dasa, John W Petersen, Madeline Smoot, Emily S Edwards, Sujay R Kamisetty, Mamoun T Mardini","doi":"10.1007/s10286-024-01089-2","DOIUrl":"10.1007/s10286-024-01089-2","url":null,"abstract":"<p><strong>Introduction: </strong>Syncope is common, with bimodal distribution through life, peaking in adolescence and in the elderly, and overall increases in incidence with age among both men and women. In this context, syncope-related visits to emergency departments (ED), hospitalizations, and testing are a significant healthcare cost burden. Ultimately, understanding the volume of testing types and settings of syncope encounters may aid in more effective healthcare utilization and high value care for this patient population.</p><p><strong>Methods: </strong>Data for this study were collected from the Truven Health Analytics MarketScan Database from 2006 to 2019. This database contains both commercially insured patients and those with Medicare coverage. Patients with the diagnosis of syncope were identified using International Classification of Diseases (ICD)-9 and -10 codes. We assessed the incidence of various tests for syncope evaluation and ED disposition for the study period.</p><p><strong>Results: </strong>The incidence of syncope among the study cohort rose from nine per 1000 patients to 13 per 1000 patients during the study period. The incidence of testing for syncope among multiple domains (neurologic, cardiac, blood testing) decreased in some categories, but routine testing remained prevalent. Women had a significantly lower incidence of testing in most testing domains. Discharge rate from the ED for patients presenting with syncope remained stable during the study period. However, admission rate to the hospital for those aged > 65 years increased during the study time.</p><p><strong>Conclusion: </strong>Testing and admissions for syncope remain prevalent and are drivers of healthcare-associated costs. There is a clear need for further work in developing a focused approach in the evaluation of syncope patients in order to mitigate healthcare costs and improve outcomes.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667305","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}