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Clinical Autonomic Research
Erschienen in: Clinical Autonomic Research 6/2015

01.12.2015 | Research Article

Simple cardiovagal and adrenergic function tests in carotid artery stenosis patients as a potential tool for determining a transient autonomic dysfunction

verfasst von: Viktor Švigelj, Matjaž Šinkovec, Viktor Avbelj, Roman Trobec

Erschienen in: Clinical Autonomic Research | Ausgabe 6/2015

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Abstract

Purpose

The arterial baroreflex depends on the integrity of the afferent limb, which can be quantified using the baroreceptor’s sensitivity (BRS) during the Valsalva maneuver (VM). The aim of this study was to evaluate, using autonomic nervous system tests, the autonomic function in patients after a carotid artery angioplasty (CAS).

Methods

We evaluated the changes in blood pressure (BP) during the VM (Valsalva ratio, BRS, sympathetic indexes) in 41 patients with symptomatic, unilateral, internal carotid artery stenosis.

Results

The Valsalva ratio between the baseline and the post-procedural day (1.3 ± 0.1 vs 1.44 ± 0.3; P = 0.002) and the post-procedural day and a month later (1.44 ± 0.3 vs 1.3 ± 0.3; P = 0.0002) revealed significant differences. This was confirmed with a cardiovagal BRS test. However, the adrenergic BRS did not reveal any differences. Sympathetic indexes [BP fall (SI1) and recovery during phase 2 (SI2)] showed differences for the periods before and a day after the treatment (36.9 ± 18.0 vs 27.2 ± 21.4 and 7.1 ± 13.1 vs 3.0 ± 8.2, respectively; P = 0.004) and for SI1 a day and a month after the treatment (27.2 ± 21.4 vs 37.1 ± 21.8; P = 0.036). The dynamic ranges between S1 and S3 (the difference in the BP between the baseline and the end of phase 2) were also different (P = 0.007 and P = 0.044, respectively).

Conclusion

We found heterogeneous responses in the BP regulation obtained with the Valsalva maneuver in our patients; however, we could not confirm that CAS provoked any long-term autonomic dysfunction, except for 1 day after the procedure.
Literatur
1.
Roffi M, Sievert H, Gray WA et al (2010) Carotid artery stenting versus surgery: adequate comparisons? Lancet Neurol 9:339–341CrossRefPubMed
2.
3.
Coutts SB, Hill MD, Hu WY (2003) Hyperperfusion syndrome: toward a stricter definition. Neurosurgery 53:1053–1058CrossRefPubMed
4.
Karapanayiotides T, Meuli R, Devuyst G et al (2005) Postcarotid endarterectomy hyperperfusion or reperfusion syndrome. Stroke 36:21–26CrossRefPubMed
5.
Bouri S, Thapar A, Shalhoub J et al (2011) Hypertension and the post-carotid endarterectomy cerebral hyperperfusion syndrome. Eur J Vasc Endovasc Surg 41:229–237CrossRefPubMed
6.
van Mook WN, Rennenberg RJ, Schurink GW et al (2005) Cerebral hyperperfusion syndrome. Lancet Neurol 4:877–888CrossRefPubMed
7.
Canovas D, Estela J, Perendreu J et al (2012) Cerebral hyperperfusion syndrome after angioplasty. In: Forbes T (ed) Angioplasty, various techniques and challenges in treatment of congenital and acquired vascular stenoses. InTech, Rijeka, pp 9–40
8.
Ogasawara K, Mikami C, Inoue T, Ogawa A (2004) Delayed cerebral hyperperfusion syndrome caused by prolonged impairment of cerebrovascular autoregulation after carotid endarterectomy: case report. Neurosurgery 54:1258–1262CrossRefPubMed
9.
Ahn SS, Marcus DR, Moore WS (1989) Post-carotid endarterectomy hypertension: association with elevated cranial norepinephrine. J Vasc Surg 9:351–360CrossRefPubMed
10.
Timmers HJ, Wieling W, Karemaker JM, Lenders JW (2004) Baroreflex failure: a neglected type of secondary hypertension. Neth J Med 62:151–155PubMed
11.
Cayne NS, Faries PL, Trocciola SM et al (2005) Carotid angioplasty and stent-induced bradycardia and hypotension: impact of prophylactic atropine administration and prior carotid endarterectomy. J Vasc Surg 41:956–961CrossRefPubMed
12.
Benarroch EE, Opfer-Gehrking TL, Low PA (1991) Use of the photoplethysmographic technique to analyze the Valsalva maneuver in normal man. Muscle Nerve 14:1165–1172CrossRefPubMed
13.
Denq J-C, O’Brien PC, Low PA (1998) Normative data on phases of Valsalva maneuver. J Clin Neurophysiol 15:535–540CrossRefPubMed
14.
von Reutern GM, Goertler MW, Bornstein NM et al (2012) Recommendations for grading carotid stenosis by means of ultrasonic methods. Stroke 43:916–921CrossRef
15.
Hamilton WF, Woodbury RA, Harper HT Jr (1936) Physiologic relationships between intrathoracic, intraspinal and arterial pressures. JAMA 107:853–856CrossRef
16.
LeWinter MM (2001) Normal physiology of the cardiovascular system. In: Fuster V, Alexander W, Wellens GJJ (eds) Hurst’s the heart, 10th edn. McGraw-Hill, Maidenheach, pp 63–94
17.
Kjeldsen S, Feldman RD, Lisheng L et al (2014) Updated national and international hypertension guidelines: a review of current recommendations. Drugs 74:2033–2051PubMedCentralCrossRefPubMed
18.
19.
Schrezenmaier C, Singer W, Muenter Swift N, Sletten D, Tanabe J, Low PA (2007) Adrenergic and vagal baroreflex sensitivity in autonomic failure. Arch Neurol 64:381–386CrossRefPubMed
20.
Vogel ER, Sandroni P, Low PA (2005) Blood pressure recovery from Valsalva maneuver in patients with autonomic failure. Neurology 65:1533–1537CrossRefPubMed
21.
Persson PB, DiRienzo M, Castiglioni P et al (2001) Time versus frequency domain techniques for assessing baroreflex sensitivity. J Hypertens 19:1699–1705CrossRefPubMed
22.
23.
Weston PJ, James MA, Panerai R et al (1996) Abnormal baroreceptor-cardiac reflex sensitivity is not detected by conventional tests of autonomic function in patients with insulin-dependent diabetes mellitus. Clin Sci (London) 91:59–64CrossRef
24.
Pitzalis MV, Mastropasqua F, Passantino A et al (1998) Comparison between noninvasive indices of baroreceptor sensitivity and the phenylephrine method in postmyocardial infarction patients. Circulation 97:1362–1367CrossRefPubMed
25.
Pickering TG, Gribbin B, Sleight P (1972) Comparison of the reflex heart rate response to rising and falling arterial pressure in man. Cardiovasc Res 6:277–283CrossRefPubMed
26.
Milic M, Sun P, Liu F et al (2009) A comparison of pharmacologic and spontaneous baroreflex methods in aging and hypertension. J Hypertens 27:1243–1251PubMedCentralCrossRefPubMed
27.
Yakhou L, Constant I, Merle JC, Laude D, Becquemin JP, Duvaldestin P (2006) Noninvasive investigation of autonomic activity after carotid stenting or carotid endarterectomy. J Vasc Surg 44:472–479CrossRefPubMed
28.
Huang C-C, Wu Y-S, Chen T et al (2010) Long-term effects of baroreflex function after stenting in patients with carotid artery stenosis. Auton Neurosci 158:100–104CrossRefPubMed
29.
Bishop VS, Haywood JR, Shade RE, Siegel M, Hamm C (1986) Aortic baroreceptor deafferentation in the baboon. J Appl Physiol 60:798–801PubMed
30.
Shade RE, Bishop VS, Haywood JR, Hamm CK (1990) Cardiovascular and neuroendocrine responses to baroreceptor denervation in baboons. Am J Physiol 258:R930–R938PubMed
31.
Timmers HJ, Karemaker JM, Wieling W, Buskens FG, Lenders JW (2001) Arterial barroreflex function after unilateral carotid endarterectomy. Clin Auton Res 11:188–189
32.
Mangin L, Medigue C, Merle JC et al (2003) Cardiac autonomic control during balloon carotid angioplasty and stenting. Can J Physiol Pharmacol 81:944–951CrossRefPubMed
33.
Gianaros PH, Jennings JR, Olafsson GB et al (2002) Greater intima-media thickness in the carotid bulb is associated with reduced baroreflex sensitivity. Am J Hypertens 15:486–491PubMedCentralCrossRefPubMed
34.
Lábrová R, Honzíková N, Maděrová E et al (2005) Age-dependent relationship between the carotid intima-media thickness, baroreflex sensitivity, and the inter-beat interval in normotensive and hypertensive subjects. Physiol Res 54:593–600PubMed
35.
Metadaten
Titel
Simple cardiovagal and adrenergic function tests in carotid artery stenosis patients as a potential tool for determining a transient autonomic dysfunction
verfasst von
Viktor Švigelj
Matjaž Šinkovec
Viktor Avbelj
Roman Trobec
Publikationsdatum
01.12.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Clinical Autonomic Research / Ausgabe 6/2015
Print ISSN: 0959-9851
Elektronische ISSN: 1619-1560
DOI
https://doi.org/10.1007/s10286-015-0316-8

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