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Cardiac and Vascular Sympathetic Baroreflex Control during Orthostatic Pre-Syncope.
J Clin Med 2019; 8(9)JC

Abstract

We hypothesized that sympathetic baroreflex mediated uncoupling between neural sympathetic discharge pattern and arterial pressure (AP) fluctuations at 0.1 Hz during baroreceptor unloading might promote orthostatic pre-syncope. Ten volunteers (32 ± 6 years) underwent electrocardiogram, beat-to-beat AP, respiratory activity and muscle sympathetic nerve activity (MSNA) recordings while supine (REST) and during 80° head-up tilt (HUT) followed by -10 mmHg stepwise increase of lower body negative pressure until pre-syncope. Cardiac and sympathetic baroreflex sensitivity were quantified. Spectrum analysis of systolic and diastolic AP (SAP and DAP) and calibrated MSNA (cMSNA) variability assessed the low frequency fluctuations (LF, ~0.1 Hz) of SAP, DAP and cMSNA variability. The squared coherence function (K2) quantified the coupling between cMSNA and DAP in the LF band. Analyses were performed while supine, during asymptomatic HUT (T1) and at pre-syncope onset (T2). During T2 we found that: (1) sympathetic baroreceptor modulation was virtually abolished compared to T1; (2) a progressive decrease in AP was accompanied by a persistent but chaotic sympathetic firing; (3) coupling between cMSNA and AP series at 0.1 Hz was reduced compared to T1. A negligible sympathetic baroreceptor modulation during pre-syncope might disrupt sympathetic discharge pattern impairing the capability of vessels to constrict and promote pre-syncope.

Authors+Show Affiliations

Department of Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas University, 20089 Rozzano, Italy. raffaello.furlan@hunimed.eu.Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany. Karsten.Heusser@dlr.de.Department of Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas University, 20089 Rozzano, Italy. maura.minonzio@humanitas.it.Department of Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas University, 20089 Rozzano, Italy. dana.shiffer@humanitas.it.Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy. beatrice.cairo@unimi.it.Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany. Jens.Tank@dlr.de.Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany. Jens.Jordan@dlr.de. Chair of Aerospace Medicine, University of Cologne, 51147 Cologne, Germany. Jens.Jordan@dlr.de.Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA. andre.diedrich@vumc.org.Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany. Peter.Gauger@dlr.de.Departamento de Kinesiología, Universidad Católica del Maule, 3530000 Talca, Maule, Chile. beto.zam@gmail.com.Department of Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas University, 20089 Rozzano, Italy. franca.dipaola@humanitas.it.Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy. alberto.porta@unimi.it. Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico di San Donato, 20097 San Donato Milanese, Italy. alberto.porta@unimi.it.Department of Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas University, 20089 Rozzano, Italy. franca.barbic@humanitas.it.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31510103

Citation

Furlan, Raffaello, et al. "Cardiac and Vascular Sympathetic Baroreflex Control During Orthostatic Pre-Syncope." Journal of Clinical Medicine, vol. 8, no. 9, 2019.
Furlan R, Heusser K, Minonzio M, et al. Cardiac and Vascular Sympathetic Baroreflex Control during Orthostatic Pre-Syncope. J Clin Med. 2019;8(9).
Furlan, R., Heusser, K., Minonzio, M., Shiffer, D., Cairo, B., Tank, J., ... Barbic, F. (2019). Cardiac and Vascular Sympathetic Baroreflex Control during Orthostatic Pre-Syncope. Journal of Clinical Medicine, 8(9), doi:10.3390/jcm8091434.
Furlan R, et al. Cardiac and Vascular Sympathetic Baroreflex Control During Orthostatic Pre-Syncope. J Clin Med. 2019 Sep 10;8(9) PubMed PMID: 31510103.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiac and Vascular Sympathetic Baroreflex Control during Orthostatic Pre-Syncope. AU - Furlan,Raffaello, AU - Heusser,Karsten, AU - Minonzio,Maura, AU - Shiffer,Dana, AU - Cairo,Beatrice, AU - Tank,Jens, AU - Jordan,Jens, AU - Diedrich,André, AU - Gauger,Peter, AU - Zamuner,Antonio Roberto, AU - Dipaola,Franca, AU - Porta,Alberto, AU - Barbic,Franca, Y1 - 2019/09/10/ PY - 2019/08/01/received PY - 2019/09/04/revised PY - 2019/09/05/accepted PY - 2019/9/13/entrez KW - MSNA variability KW - baroreceptors KW - blood pressure variability KW - heart rate variability KW - muscle sympathetic nerve activity KW - power spectrum analysis KW - syncope KW - vasovagal JF - Journal of clinical medicine JO - J Clin Med VL - 8 IS - 9 N2 - We hypothesized that sympathetic baroreflex mediated uncoupling between neural sympathetic discharge pattern and arterial pressure (AP) fluctuations at 0.1 Hz during baroreceptor unloading might promote orthostatic pre-syncope. Ten volunteers (32 ± 6 years) underwent electrocardiogram, beat-to-beat AP, respiratory activity and muscle sympathetic nerve activity (MSNA) recordings while supine (REST) and during 80° head-up tilt (HUT) followed by -10 mmHg stepwise increase of lower body negative pressure until pre-syncope. Cardiac and sympathetic baroreflex sensitivity were quantified. Spectrum analysis of systolic and diastolic AP (SAP and DAP) and calibrated MSNA (cMSNA) variability assessed the low frequency fluctuations (LF, ~0.1 Hz) of SAP, DAP and cMSNA variability. The squared coherence function (K2) quantified the coupling between cMSNA and DAP in the LF band. Analyses were performed while supine, during asymptomatic HUT (T1) and at pre-syncope onset (T2). During T2 we found that: (1) sympathetic baroreceptor modulation was virtually abolished compared to T1; (2) a progressive decrease in AP was accompanied by a persistent but chaotic sympathetic firing; (3) coupling between cMSNA and AP series at 0.1 Hz was reduced compared to T1. A negligible sympathetic baroreceptor modulation during pre-syncope might disrupt sympathetic discharge pattern impairing the capability of vessels to constrict and promote pre-syncope. SN - 2077-0383 UR - https://www.unboundmedicine.com/medline/citation/31510103/Cardiac_and_Vascular_Sympathetic_Baroreflex_Control_during_Orthostatic_Pre-Syncope DB - PRIME DP - Unbound Medicine ER -