Autonomic Modulation In Patients Research Articles

Cardiovascular Autonomic Modulation in Chronic Coronary Syndrome Following Percutaneous Coronary Intervention.

Introduction The risk of sudden death in patients with chronic coronary syndrome (CCS) is increased by unbalanced cardiovascular autonomic function. Since myocardial ischemia appears to be the causeof this condition of autonomic dysregulation, treating this condition should improve and correct the autonomic functions. Improving myocardial perfusion by PCI might have beneficial effects on the recovery of autonomic balance in ischemia-triggered autonomic dysregulation. Objective In the present study, autonomic modulation in patients with CCS was evaluated before and after percutaneous coronary intervention (PCI) using cardiovascular reflex tests. Methods A total of 30CCS patients were recruited from the cardiology outpatient department. The patients were tested withcardiovascular reflex tests (lying to standing, 30:15 ratio, Valsalva ratio, isometric handgrip test, and deep breathing test) before and after PCI. The licensed statistical software SPSS version 21.0 was used to compile and analyse the data. Results Out of 30 patients, parasympathetic reactivity tests conducted post-PCI were significantly higher as compared to pre-PCI patients: (1) lying to standing - 30:15 ratio (1.17± 0.102 versus 1.03± 0.064, p=0.000); (2) Valsalva ratio (1.42±0.276 versus 1.02±0.133, p=0.000), (3) delta heart rate in deep breathing test (17.23± 3.004 bpm versus 7.85± 4.076 bpm, p=0.000), and (4) expiration to inspiration (E:I) ratio (1.25± 0.050 versus 1.11± 0.064, p=0.000. Among sympathetic reactivity tests, lying to standing test for fall in systolic blood pressure was significantly higher in the pre-PCI state than post-PCI (-20.73± 10.29 versus -2.33± 7.67, p=0.000). The rise in DBP of the isometric handgrip test was significantly higher in post-PCI compared to pre-PCI patients (36.73±8.39 mm Hg versus 16.63±8.47 mm Hg, p=0.000). Conclusion Resting autonomic tone as determined by cardiovascular reflex testing reveals an increase in both parasympathetic and sympathetic reactivity following PCI in CCS, according to the findings of this preliminary study. As a result, we propose that noninvasive procedures like cardiovascular reflex tests be used to stratify the likelihood of illness development in the future.

Analysis of Autonomic Modulation in Patients with Chronic Obstructive Pulmonary Disease

The aim of this study was to analyze autonomic modulation and factors that may be associated in patients with COPD. We carried out a cross-sectional, observational study of a quantitative nature, from the recruitment of 11 individuals with COPD, assisted by a specialized hospital in the state of Ceará. For data collection, the following were used: an evaluation form containing demographic and clinical data, prepared by the researchers; a cardiofrequency meter to measure the heart rate during and after the walk test; the Duke Activity Status Index (DASI) questionnaire to assess the capacity functional scale, the London Chest Activity of Daily Living (LCADL) scale to check the level of dyspnea and the State-Trait Anxiety Inventory (STAI) and Beck Anxiety Inventory (BAI) to analyze the level of anxiety. We identified the LCADL scale was significantly correlated with the BAI (r= 0.847; p=0.001). Also, we found that the DASI scale was negatively correlated with the BAI (r= -0.632; p=0.037), and it was verified that the lower the score, the greater the anxiety and the lower the performance in activities of daily living (ADLs). In this context, we observed that anxiety significantly impacts ADLs in the evaluated population.

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Pulsed Laser Acupuncture in the Treatment of Pain and Heart Rate Variability in Fibromyalgia Patients: A Pilot Randomized Clinical Trial.

Introduction: Laser acupuncture (LA) is a medically approved treatment for chronic pain, especially fibromyalgia. It is widely known that all pain is related to autonomic modulation, which may influence heart rate variability (HRV). There are robust studies in the literature on the effect of LA with continuous frequency on musculoskeletal pain and autonomic modulation. However, little is known about the effect of pulsed frequency on fibromyalgia. Therefore, this study aimed to evaluate whether an individualized intervention protocol applying pulsed LA would provide benefits related to pain symptoms and cardiac autonomic modulation in patients with fibromyalgia. Methods: In this pilot randomized clinical controlled trial, the sample consisted of women with fibromyalgia between the ages of 40 and 80, randomized into two groups: a control group (CG; n=10) and an experimental group (EG; n=10). EG received the intervention twice per week for 3 weeks. Statistical analysis was conducted by delta (difference between post-intervention and pre-intervention) and the Shapiro-Wilk test (normality). For comparison between the groups, the Mann-Whitney test was used. Results: The results showed a significant reduction in pain intensity as reported via the pain numerical scale (PNS; P=0.00), generalized pain index (GPI; P=0.00), and symptom severity scale (SSS; P=0.00). There was no significant difference in any HRV variable (P>0.05). Conclusion: Pulsed LA, when applied in an individualized protocol, can reduce pain intensity, as reported on the PNS, GPI, and SSS. However, no therapeutic effect was observed for HRV.

Physical Exercise Affects Quality of Life and Cardiac Autonomic Modulation in Patients With Chronic Kidney Failure Submitted to Hemodialysis: A Randomized Clinical Trial.

Performing physical exercise during hemodialysis has been debated regarding safety and efficacy for improving life quality for patients with chronic kidney disease (CKD). Thus, we explored the influence of physical exercise during hemodialysis on both autonomic modulation of heart rate and quality of life for patients with CKF in a randomized clinical trial. We randomly allocated participants requiring hemodialysis to an experimental exercise group (EG) and a control no-exercise group (CG) and assessed their quality of life with the Kidney Disease Quality of Life Short Form-KDQOL-SF™ 1.3 and with Polar RS800CX to monitor their heart rate variability (HRV) before and threemonths after the end of the exercise intervention. EG participants reported a significant increase in their quality of life (p = .05, physical function, physical aspects, pain, emotional well-being, emotional function; p = .03, energy and fatigue) and showed HRV improvement (p = .05, RMSSD, SDNN, and SD2; p = .004, SD1) after threemonths of exercise. Thus, we recommend supervised physical exercise during hemodialysis for carefully selected patients.

Relationship between the number of comorbidities, quality of life, and cardiac autonomic modulation in patients with coronary disease: a cross-sectional study.

The aim of this study was to evaluate if there is a relationship between the number of comorbidities, autonomic modulation, and quality of life in patients diagnosed with coronary artery disease. A cross-sectional study was conducted at an outpatient rehabilitation center in Presidente Prudente-SP, Brazil. A total of 27 participants (65.33±9.23 years) diagnosed with coronary artery disease were assessed, from a cardiac rehabilitation program, independent of sex or age. The number of comorbidities was evaluated using the Self-Administered Comorbidity Questionnaire, and quality of life was evaluated using the Medical Outcome Study 36-Item Short Form Health Survey (SF-36) (eight domains: functional capacity, physical aspects, pain, general health status, vitality, social aspects, emotional aspects, and mental health). To evaluate the cardiac autonomic modulation, the heart rate was registered beat to beat using an heart rate monitor in the supine position during rest for 30 min. A total of 1000 RR intervals were considered to calculate linear (time domain: RMSSD, SDNN; frequency domain: LF, HF, LF/HF) and nonlinear indices (SD1, SD2, SD1/SD2) of heart rate variability. A negative correlation was observed between the aggregation of comorbidities and the pain domain of the SF-36 (r=-0.427; p=0.03). No significant correlations were observed between other variables (p>0.05). The number of comorbidities is inversely related to the pain domain of the SF-36, suggesting that a higher pain level is related to a higher number of comorbidities in coronary artery disease patients.

High-Intensity Interval Training Improves Cardiac Autonomic Function in Patients with Type 2 Diabetes: A Randomized Controlled Trial.

Simple SummaryDiabetes mellitus is a metabolic disorder characterized by an increased blood glucose concentration. The most common diabetes is type 2, corresponding to approximately 95% of the diagnosed cases. Chronic hyperglycemia can lead to many complications such as increased incidence of cardiovascular diseases as well as renal and ophthalmologic complications. Physical exercise is seen as an effective non-pharmacological strategy for managing the disease. In the present study, 44 middle-aged adults with type 2 diabetes were recruited and stratified into three exercise groups: HIIT-30:30, HIIT-2:2, and MICT. All patients were submitted to anamnesis, evaluation of cardiorespiratory fitness, and cardiac autonomic modulation, and were submitted to physical exercise programs for eight weeks. From the results found, it was possible to infer that high intensity physical training programs can be safe and effective for patients with type 2 diabetes and might be performed in different phases of a rehabilitation program. However, it is necessary to know how to work with the prescription of these exercises considering its cost effectiveness, because, in this study, the protocols HIIT-2:2 and HIIT-30:30 presented superior benefits to the MICT protocol.Different exercise models have been used in patients with type 2 diabetes mellitus (T2D), like moderate intensity continuous training (MICT) and high intensity interval training (HIIT); however, their effects on autonomic modulation are unknown. The present study aimed to compare the effects of different exercise modes on autonomic modulation in patients with T2D. In total, 44 adults with >5 years of T2D diagnosis were recruited and stratified into three groups: HIIT-30:30 (n = 15, age 59.13 ± 5.57 years) that performed 20 repetitions of 30 s at 100% of VO2peak with passive recovery, HIIT-2:2 (n = 14, age 61.20 ± 2.88) that performed 5 repetitions of 2 min at 100% of VO2peak with passive recovery, and MICT (n = 15, age 58.50 ± 5.26) that performed 14 min of continuous exercise at 70% of VO2peak. All participants underwent anamnesis and evaluation of cardiorespiratory fitness and cardiac autonomic modulation. All protocols were equated by total distance and were performed two times per week for 8 weeks. Group × time interactions were observed for resting heart rate (HRrest) [F(2.82) = 3.641; p = 0.031] and SDNN [F(2.82) = 3.462; p = 0.036]. Only the HIIT-30:30 group significantly reduced SDNN (p = 0.002 and 0.025, respectively). HRrest reduced more in the HIIT-30:30 group compared with the MICT group (p = 0.038). Group × time interactions were also observed for offTAU [F(2.82) = 3.146; p = 0.048] and offTMR [F(2.82) = 4.424; p = 0.015]. The MICT group presented increased values of offTAU compared with the HIIT-30:30 and HIIT-2:2 groups (p = 0.001 and 0.013, respectively), representing a slower HR response after eight weeks of intervention. HIIT, specially HIIT-30:30, represents a promising measure for improving autonomic modulation in patients with T2D.

Impact of hypertension on arterial stiffness and cardiac autonomic modulation in patients with peripheral artery disease: a cross-sectional study.

ABSTRACTObjective:To examine the impact of hypertension on cardiovascular health in patients with symptomatic peripheral artery disease and to identify factors associated with uncontrolled hypertension.Methods:A cross-sectional study including 251 patients with symptomatic peripheral artery disease (63.9% males, mean age 67±10 years). Following hypertension diagnosis, blood pressure was measured to determine control of hypertension. Arterial stiffness (carotid-femoral pulse wave velocity) and cardiac autonomic modulation (sympathovagal balance) were assessed.Results:Hypertension was associated with higher carotid-femoral pulse wave velocity, regardless of sex, age, ankle-brachial index, body mass index, walking capacity, heart rate, or comorbidities (ß=2.59±0.76m/s, b=0.318, p=0.003). Patients with systolic blood pressure ≥120mmHg had higher carotid-femoral pulse wave velocity values than normotensive individuals, and hypertensive patients with systolic blood pressure of ≤119mmHg (normotensive: 7.6±2.4m/s=≤119mmHg: 8.1±2.2m/s 120-129mmHg:9.8±2.6m/s=≥130mmHg: 9.9±2.9m/s, p<0.005). Sympathovagal balance was not associated with hypertension (p>0.05).Conclusion:Hypertensive patients with symptomatic peripheral artery disease have increased arterial stiffness. Arterial stiffness is even greater in patients with uncontrolled high blood pressure.

Anatomic guided ablation of the atrial right ganglionated plexi is enough for cardiac autonomic modulation in patients with significant bradyarrhythmias

IntroductionCardiac autonomic system modulation by endocardial ablation targeting atrial ganglionated plexi (GP) is an alternative strategy in selected patients with severe functional bradyarrhythmias, although no consensus exists on the best ablation strategy. The aim of this study was to evaluate if a simplified approach by a purely anatomical guided ablation of just the atrial right GP is enough for the treatment of these patients. MethodsWe prospectively enrolled patients with significant functional bradyarrhythmias and performed endocardial ablation purely guided by 3D electroanatomic mapping directed at the atrial right GP and accessed parameters of parasympathetic modulation and recurrence of bradyarrhythmias. ResultsThirteen patients enrolled (76.9% male, median age 51, 42–63 years). After ablation, a median RR interval shortening of 28.3 (25.6–40.3)% occurred (1111, 937.5–1395.4 ms to 722.9, 652.2–882.4 ms, p = 0.0002). The AH interval also shortened (19, 10.5–35.7%) significantly after the procedure (115, 105–122 ms to 85, 71–105 ms, p = 0.0023) as well as Wenckebach cycle length (11.1, 5.9–17.8% shortening) from 450, 440–510 ms to 430, 400–460 ms, p = 0.0127. On 24-h Holter monitoring there was significant increase in heart rates (HR) of patients after ablation (minimal HR increased from 34 (26–43)bpm to 49 (43–56)bpm, p = 0,0102 and mean HR from 65 (47–72)bpm to 78 (67–87)bpm, p = 0.0004). No patients had recurrence of symptoms or significant bradyarrhythmias during a median follow-up of 8.4 months. ConclusionsA purely anatomic guided procedure directed only at the atrial right ganglionated plexi seems to be enough as a therapeutic approach for cardioneuroablation in selected patients with significant functional bradyarrhythmias.

Cardiovascular Autonomic Modulation during Metronomic Breathing and Stress Exposure in Patients with Borderline Personality Disorder

Introduction: Given the growing evidence of reduced heart rate variability in psychiatric diseases associated with emotional instability, we investigated cardiovascular autonomic modulation in patients with borderline personality disorder (BPD) during resting state, parasympathetic stimulation (metronomic breathing), and sympathetic stimulation (mental arithmetic stress test). Methods: In 29 BPD outpatients and 30 controls, we recorded RR-intervals (RRI), blood pressure, skin conductance levels, and respiratory frequency during resting state, metronomic breathing, stress anticipation, stress exposure, and stress recovery. We calculated baroreflex sensitivity (BRS) and parameters of heart rate variability, including the root mean square of successive differences (RMSSD), an index of cardiovagal modulation. Results: During resting state, BPD patients showed higher blood pressure and shorter RRI, as well as lower RMSSD and BRS than controls. Metronomic breathing increased RMSSD and BRS in BPD patients. During the stress exposure, BRS significantly decreased in controls, but not in BPD patients. Furthermore, BPD patients showed less cardioacceleration in response to stress exposure than controls. During stress recovery, we found increases in RMSSD and BRS in controls, but not in BPD patients. Conclusion: Our data show reduced cardiovascular autonomic modulation in BPD patients during resting state, psychophysiological relaxation, and stress exposure. The results indicate a vagal modulation deficit in this cohort. Breathing techniques, such as metronomic breathing, might be helpful to reduce stress and to increase vagal tone in BPD patients.

Effect of different modalities of exercise on cardiac autonomic modulation in patients with coronary artery disease: a systematic review

Effect of different modalities of exercise on cardiac autonomic modulation in patients with coronary artery disease: a systematic review

Spinal manipulation effect on pain and cardiac autonomic modulation in patients with rotator cuff tendinopathy: a pilot study

Introduction: there are few studies that propose to identify the relationship of Vertebral Manipulation (VM) on pain and cardiac autonomic modulation, especially in subjects with rotator cuff injury. Objective: To analyze the effect of chest VM on the pain and cardiac autonomic modulation in patients with rotator cuff (RC). Method: quasi-experimental study with a quantitative approach. Sample of 6 subjects divided into two groups: Asymptomatic Group (AG, n = 3) not presenting shoulder injury and pain complaints and Symptomatic Group (SG, n = 3), with rotator cuff injury. Pain assessment was performed by Visual Analog Scale (VAS) before and after handling, as well as the assessment of Heart Rate Variability (HRV) using an electrocardiogram (ECG) with 8 minutes of duration. Chest VM was held on 4th and 5th thoracic vertebra. The analysis of HRV was performed in the Frequency Domain (VLF-very low frequency, LF-low frequency, HF-high frequency, LF/HF-ratio between low and high frequency). The statistical analysis used the Wilcoxon test for comparison in the same group and the Mann Whitney test for comparison between groups, adopting a 5% significance (p &lt;0.05). Results: There was a reduction of post handling pain, but no statistically significant difference in SG (p=0.317). In HRV the AG showed a decrease VLF (p=0.83) and increased LF (p=0.51), HF (p=0.83) and LF/HF (p=0.51) variables. In the SG, there was an increase in VLF (p=0.83), LF (p=0.83), HF (p=0.51) variables and a decrease in LF/HF (p=0.51) variable. Conclusion: The upper thoracic VM had no effect on the pain and cardiac autonomic modulation in patients with rotator cuff (RC).

Evaluation of the QTc internal and QT dispersion in patients with newly detected clinical hypothyroidism

Background: Thyroid hormones play an important role in the orchestration of various metabolic functions in the body and thus thyroid dysfunction can produce dramatic cardiovascular effects. Electrocardiographic changes such as bradycardia, low voltage complexes, and varying degrees of heart block are commonly recognized in hypothyroid patients. Hypothyroidism has been found to be associated with increased cardiovascular morbidity and mortality. Hence, it is important to investigate the ECG profile in these patients. The present study was aimed at evaluating the QTc interval and QT dispersion, an indicator of inhomogeneity of ventricular repolarisation and cardiac autonomic modulation in patients with newly detected clinical hypothyroidism.Methods: 50 patients with newly detected clinical hypothyroidism and 50 healthy controls were included in the study. The ECG was recorded and the heart-rate, QTc interval and QT dispersion were calculated.Results: The mean heart-rate was found to be significantly (p &lt;0.05) reduced in hypothyroid patients when compared to healthy controls. The mean QTc interval and QT dispersion were significantly increased in hypothyroid patients when compared to controls. QTmin and QTmax of cases and controls also showed a statistically significant difference.Conclusion: Thus, the present study confirms the role of thyroid hormones on the cardiovascular system, particularly on ventricular repolarisation and cardiac autonomic modulation. Hence, early and prompt therapy with levothyroxine may help to prevent the adverse events resulting from cardiovascular dysfunction.

Diabetes Impairs Walking Capacity And Autonomic Function In Patients With Peripheral Artery Disease

Diabetes is a high prevalent comorbid condition in patients with peripheral arterial disease (PAD). Previous studies showed that diabetes impair physical function in PAD patients. However, whether cardiovascular function is also affected by diabetes is unknown. PURPOSE: To compare walking capacity and cardiovascular function in PAD patients with and without diabetes. A total of 80 patients (n=41 non-diabetic and n=39 diabetic) with PAD were recruited. Six-minute walk test (total walking capacity), 4-meter test, walking impairment questionnaire (WIQ) and the walking estimated-limitation calculated by history (WELCH) were used to assess walking capacity. Cardiovascular function was assessed by blood pressure, arterial stiffness, heart rate variability and flow-mediated dilation. Mann-Whitney U test were performed, and data are presented in median and interquartile range. RESULTS: Diabetic PAD patients presented lower total walking capacity (308 ± 120 m vs. 370 ± 125m, p=0.025), WIQ distance score (10 ±23 vs. 30 ±46, p=0.002), WIQ speed score (17 ± 21 vs. 28 ± 27, p=0.001), WIQ stairs score (21 ± 42 vs. 42 ± 42, p=0.024), WELCH total score (20 ± 26 vs. 40 ± 42, p=0.006) compared to non-diabetic PAD patients. In addition, diabetic PAD patients had lower SDNN (22 ± 21 vs. 29 ± 36, p=0.030), and a trend to have lower RMSSD (13 ± 19 vs. 19 ± 32, p=0.061), and PNN50 (0.4 ± 3.7 vs. 1.6 ±21.0, p=0.072). The remaining variables were similar between PAD patients with and without diabetes. CONCLUSION: Diabetes impairs walking capacity and cardiac autonomic modulation in patients with PAD. Therefore, interventions to improve these parameters should be emphasized in diabetic PAD patients. Supported by FAPESP (# 2016/16425-9) and CNPq (#310508/2017-7)

Influence of smoking on physical function, physical activity, and cardiovascular health parameters in patients with symptomatic peripheral arterial disease: A cross-sectional study

The aim of this study was to analyze the impact of smoking on physical activity, walking capacity, and cardiovascular health in patients with symptomatic peripheral arterial disease (PAD). This cross-sectional study included 180 patients with symptomatic PAD. Patients were classified into 3 groups according to smoking history: smoker (n=39), ex-smoker (n=113), and never smoker (n=28). Physical activity levels, physical function, walking capacity, and cardiovascular health parameters (clinical blood pressure, arterial stiffness, and heart rate variability) were assessed. Smoker patients presented higher sympathetic modulation to the heart (low frequency of heart rate variability: smokers, 71±17 nu; ex-smokers, 53±32 nu; never smokers, 49±21 nu, P<.05) and sympathovagal balance (smokers: 2.44±2.76, ex-smokers: 1.14±1.74, never smokers: 1.04±0.99, P<.05) and lower parasympathetic modulation to the heart (high frequency of heart rate variability: smokers, 29±27 nu; ex-smokers, 47±32 nu; never smokers, 51±21 nu, P<.05) than other patients. In conclusion, nonsignificant differences were observed on physical activity levels, physical function, blood pressure, and arterial stiffness (P>.05). Smoking impairs cardiac autonomic modulation in patients with symptomatic PAD.

Effect of manual and air nonsurgical periodontal therapy on systolic and diastolic blood pressure

Aims and Objectives: The blood pressure (BP) variability is a useful method to assess cardiac autonomic modulation in patients undergoing dental procedures because the knowledge of physiological conditions provides greater security to the professional as well as the possibility of a better plan treatment to patient benefit. The aim of our study was to study the association between BP and nonsurgical periodontal treatment. Materials and Methods: The research was carried out on 150 patients in Baghdad, all of them divided into two groups, first group: 75 patients, periodontal treatment for those groups was carried out by air scaling, second group: 75 patients, periodontal therapy for those groups was carried out by manual scaling. After the participants rested for ≥5min, we measured the systolic BP (SBP) and diastolic BP (DBP) three times (1–2min) in between for each participant in both groups by using mercury sphygmomanometer and bell stethoscope on the right arm of the patients while they were in sitting position. We used Community Periodontal Index for Treatment Need (CPITN) to determine the periodontal health status and the treatment needed for the study groups. Results: The results of this study revealed that the SBP and DBP mean values for the manual and air scaling groups had a significant increase after the scaling due to the pain and anxiety during therapy. The association between BP and CPITN was even stronger among participants with the time. Conclusion: This study showed that nonsurgical periodontal treatment led to elevated BP levels during therapy in correlation to the time and CPITN.

Elastic Tubing Resistance Training and Autonomic Modulation in Subjects with Chronic Obstructive Pulmonary Disease.

This study addresses evidence concerning elastic tubing resistance training (ET) on autonomic modulation in patients with chronic obstructive pulmonary disease (COPD). Autonomic dysfunction is common in COPD and contributes to the development of arrhythmias and sudden death. Along with autonomic dysfunction, muscle dysfunction is related to functional limitations and prognosis of the disease. This study investigated the effects of ET on autonomic modulation, muscle strength, and walking distance in COPD. Subjects were divided into two groups, ET (n = 20; 66,5 ± 8,9 y; 25,5 ± 3,5 kg/m2; FEV1/FVC: 50,3 ± 11,0) and conventional training (n = 19; 66,0 ± 6,9; 27,1 ± 4,3; FEV1/FVC: 55,05 ± 9,56). Both groups undertook 24 sessions for 60 minutes, 3 times in a week. The significance level was p ≤ 0,05. Autonomic modulation was evaluated using heart rate variability in the time (rMSSD, ms) and frequency domain (HF, ms). Strength for upper and lower limbs was measured using dynamometry and walking distance was measured using a 6-minute walking test. There were no significant differences in the outcomes between groups. There was an increment to rMSSD [(16,7 ± 11,0 versus 20,8 ± 14,9) versus (14,2 ± 10,0 versus 17,4 ± 12,1)], HF [(141,9 ± 191,3 versus 234,9 ± 335,7) versus (94,1 ± 123,5 versus 177,6 ± 275,5)], shoulder abduction [(50,1 ± 19,6 versus 56,9 ± 20,4) versus (50,5 ± 19,0 versus 56,9 ± 19,3)], knee flexion [(101,9 ± 34,0 versus 116,8 ± 43,3) versus (98,6 ± 21,5 versus 115,1 ± 30,8)], and walking test [(433,0 ± 84,8 versus 468,9 ± 90,8) versus (397,4 ± 99,8 versus 426,3 ± 101,6)] after training for ET and conventional training, respectively. In conclusion, ET improves autonomic modulation in COPD with additional benefits for strength and cardiorespiratory capacity similar to conventional training.

Analysis of Autonomic Modulation in Response to a Session of Aerobic Exercise at Different Intensities in Patients With Moderate and Severe COPD

Despite the many benefits of performing physical exercise in patients with chronic obstructive pulmonary disease (COPD), information on the response of acute cardiac autonomic modulation in subjects with moderate and severe COPD during and after an aerobic exercise session at different intensities is unknown. The aim of this study was to evaluate the response of cardiac autonomic modulation in patients with moderate and severe COPD during and after an aerobic exercise session at different intensities. Twenty-seven patients with COPD, divided into: Moderate Group and Severe Group, underwent an aerobic exercise sessions with intensities equivalent to 60% and 90% of velocity corresponding to peak oxygen consumption. The heart rate variability (HRV) indices were analyzed in the time and frequency domains at the following times: at rest, during exercise, immediately after, and 5, 10, and 15 minutes after exercise. In the comparison analysis between the two groups, no differences were observed in any of the HRV indices at different intensities applied. However, it was observed that the exercise caused autonomic changes when the groups were analyzed separately. Sessions of aerobic exercise influence the autonomic modulation in patients with COPD. However, COPD severity did not influence the autonomic nervous system response to exercise and recovery moments; and there was no difference between the exercise intensities

Tonic peripheral chemoreflex activation contributes to cardiac autonomic modulation at rest and impairs cardiac baroreflex sensitivity during orthostatic challenge in patients with pulmonary arterial hypertension

Patients with pulmonary arterial hypertension (PAH) often experience orthostatic hypotension, and this may be mediated, to some extent, by impaired baroreflex sensitivity (BRS). The impairment in BRS is possibly caused by multiple factors. Of note, however, accumulating evidence has supported that tonic peripheral chemoreflex activation plays a key role for autonomic impairment in diseases like systemic hypertension and heart failure, due to, in part, alterations that are also commonly found in PAH (e.g., inflammation and oxidative stress). Thus we sought to test two hypotheses: 1) patients with PAH present impaired BRS during an orthostatic challenge; 2) the peripheral chemoreflex is sensitized in patients with PAH and contributes to cardiac autonomic modulation and BRS at rest and BRS during an orthostatic challenge. Twenty non‐hypoxemic patients with PAH and 10 healthy controls (CON) were assessed. Peripheral chemosensitivity was measured via the ventilatory response to transient inhalation of pure nitrogen. Beat‐by‐beat heart rate (ECG) and arterial pressure (finger photoplethismography) were measured at seated rest and during a repeated sit‐to‐stand maneuver (six consecutive repetitions of 10‐s sit and 10‐s stand), while participants randomly inhaled 100% of O2 to inhibit the peripheral chemoreflex tonic activity (i.e., hyperoxia), and 21% of O2 as control (i.e., normoxia). Isocapnia was maintained via a rebreathing system. Cardiac autonomic modulation was quantified via heart rate variability (HRV) indexes, which were calculated in time and frequency domains. The CBRS was calculated at rest via sequence and alpha index methods, and during a sit‐to‐stand maneuver via sequence method. The PAH group showed significantly higher peripheral chemosensitivity (PAH: 0.32 ± 0.04 vs CON: 0.18 ± 0.02 L/%SpO2, P &lt; 0.05) and significantly lower CBRS during the sit‐to‐stand maneuver, compared to the CON group. Peripheral chemoreflex inhibition via hyperoxia similarly increased HRV and CBRS in both groups at rest. In addition, hyperoxia significantly increased BRS during the sit‐to‐stand maneuver only in the PAH group, and then, the BRS was normalized (i.e., attained the CON group level). In summary, this study provides novel evidence that patients with PAH present low CBRS during an orthostatic challenge. Furthermore, data supports that the peripheral chemoreflex is sensitized and tonically contributes to cardiac autonomic modulation in patients with PAH at rest, and most notably, to impaired cBRS during an orthostatic challenge.Support or Funding InformationThe study was supported by São Paulo Research Foundation, FAPESP (2015/221982; 2017/077713)This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.