Effect of Combined Mental Task and Metaboreflex Activation on Hemodynamics and Cerebral Oxygenation in Patients With Metabolic Syndrome.

Azzurrra Doneddu,Giovanna Ghiani,Romina Lecis,Seyed Alireza Hosseini Kakhak,Silvana Roberto,Gabriele Mulliri,Marco Guicciardi,Gianmarco Sainas,Virginia Pinna,Stefano Serra,Antonio Crisafulli,Raffaele Milia,Sara Magnani

doi:10.3389/fphys.2020.00397

Azzurrra Doneddu, Giovanna Ghiani + Show 11 more

Open Access

https://doi.org/10.3389/fphys.2020.00397

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Abstract

Objective: The hemodynamic response to muscle metaboreflex has been reported to be significantly altered by metabolic syndrome (MS), with exaggerated systemic vascular resistance (SVR) increments and reduced cardiac output (CO) in comparison to healthy controls (CTLs). Moreover, patients with metabolic disorders, such as type 2 diabetes, have proven to have impaired cerebral blood flow in response to exercise. Thus, we hypothesized that contemporary mental task (MT) and metaboreflex would result in reduced cerebral oxygenation (COX) in these patients.Methods: Thirteen MS patients (five women) and 14 normal age-matched CTLs (six women) were enrolled in this study. All the participants underwent five different tests, each lasting 12 min: post-exercise muscle ischemia (PEMI) to activate the metaboreflex, control exercise recovery (CER), PEMI + MT, CER + MT, and MT alone. Cerebral oxygenation was evaluated using near-infrared spectroscopy with sensors applied to the forehead. Hemodynamics were measured using impedance cardiography.Results: The main results show that MS patients had higher SVR and lower CO levels compared to the CTL group during metaboreflex activation. Stroke volume and ventricular filling and emptying rates were also significantly reduced. Moreover, when MT was added to PEMI, COX was significantly increased in the CTL group with respect to the baseline (103.46 ± 3.14%), whereas this capacity was reduced in MS patients (102.37 ± 2.46%).Conclusion: It was concluded that (1) patients with MS showed hemodynamic dysregulation during the metaboreflex, with exaggerated vasoconstriction and that (2) as compared to CTL, MS patients had reduced capacity to enhance COX when an MT superimposed the metaboreflex.

Highlights

Metabolic syndrome (MS) is constantly growing in prevalence worldwide and has reached epidemic proportions over the last two decades
The protocol was completed by all the subjects
The Kolmogorov–Smirnov test confirmed that distribution was normal for all the parameters examined; all the variables were analyzed using parametric tests

Summary

Introduction

Metabolic syndrome (MS) is constantly growing in prevalence worldwide and has reached epidemic proportions over the last two decades. Metabolic syndrome is associated with elevated incidences of circulatory abnormalities and cardiovascular events and is often the harbinger of type 2 diabetes mellitus (DM2). The International Diabetes Federation (2019) estimated that 20–25% of the global adult population suffers from MS. In people with MS, hemodynamic response to exercise is altered, with signs of impaired left ventricular systolic and diastolic function and reductions in maximal stroke volume (SV), cardiac output (CO), and heart rate (HR; Dipla et al, 2010; Roberto and Crisafulli, 2017; Ladeiras-Lopes et al, 2018; Roberto et al, 2019). Metabolic syndrome has been associated with cognitive dysfunction and poor performance in processing speed, visuospatial ability, semantic fluency, and executive function (Yaffe et al, 2004; Segura et al, 2009; van den Berg et al, 2009; Yates et al, 2012; Guicciardi et al, 2019)

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