Sustained Handgrip Research Articles

Cardiac Autonomic Neuropathy in Diabetic Peripheral Neuropathy.

Background Cardiac autonomic neuropathy (CAN) is the most underdiagnosed consequence of diabetes because standard hospital settings do not provide consistent diagnostic criteria or testing resources. It is still unclear how diabetic peripheral neuropathy (DPN) and CAN are related. Therefore, this study aimed to determine the prevalence of CAN in individuals with type 2 diabetes mellitus who had isolated DPN without other microvascular or macrovascular complications. Methodology A total of 35 type 2 diabetes mellitus patients with isolated DPN (group 1) and an equal number of sex- and age-matched patients without DPN (group 2) underwent CAN testing. Results were compared between the two groups. Results A significantly higher prevalence of isolated parasympathetic (28.57 vs. 11.42%), isolated sympathetic (22.85 vs. 8.57%), and combined autonomic dysfunction (37.14 vs. 2.85%) was found in the neuropathic group compared to the non-neuropathic group. Group 1 exhibited more abnormal parasympathetic nervous system test results and increased diastolic pressure during sustained handgrip compared to group 2 (all p-values <0.05). Conclusions A significantly higher prevalence of cardiac autonomic dysfunction is seen in patients with DPN without other microvascular or macrovascular complications, irrespective of age, sex, or duration of diabetes mellitus. Patients with a higher body mass index were found to have significantly increased cardiac autonomic dysfunction.

Comparison of isometric handgrip test among pregnant offspring of hypertensive parents and pregnant offspring of non-hypertensive parents.

A family history of hypertension is one of the important risk factors for the development of pregnancy-induced hypertension (PIH). Offspring of hypertensive parents should be screened for PIH. The isometric handgrip (IHG) test is used to assess autonomic function among them. Autonomic function dysregulation can indicate their predisposition to develop PIH later in the course of pregnancy. To compare the IHG among pregnant offspring of hypertensive parents (Group 1) and non-hypertensive parents (Group 2). This is a cross-sectional study done among 100 pregnant women in the second trimester (50 participants in each group). Blood pressure responses to sustained hand grip for 2 minutes of maximum voluntary contraction (MVC) were recorded, immediately at the end of the IHG test and after 5 minutes of the IHG test. Independent t-test and Mann-Whitney U test were used to compare the responses in two groups. There is no statistical difference in basal blood pressure and heart rate between the two groups. Group 1 exhibited a significant increase in systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared to Group 2 immediately after 2 minutes of the IHG test. There is a significant increase in SBP after 5 minutes of the IHG in Group 2. Offspring of hypertensive parents have increased sympathetic reactivity and restoration of the blood pressure is significantly less compared to offspring of normotensive parents, which may predispose them for PIH. IHG can be applied as a convenient tool to screen the population who are at risk of PIH in places like primary health centres or field screenings where IHG is one possible option.

Cardiovascular Autonomic Dysfunction in Hospitalized Patients with a Bacterial Infection: A Longitudinal Observational Pilot Study in the UK.

A temporal reduction in the cardiovascular autonomic responses predisposes patients to cardiovascular instability after a viral infection and therefore increases the risk of associated complications. These findings have not been replicated in a bacterial infection. This pilot study will explore the prevalence of cardiovascular autonomic dysfunction (CAD) in hospitalized patients with a bacterial infection. A longitudinal observational pilot study was conducted. Fifty participants were included: 13 and 37 participants in the infection group and healthy group, respectively. Recruitment and data collection were carried out during a two-year period. Participants were followed up for 6 weeks: all participants' cardiovascular function was assessed at baseline (week 1) and reassessed subsequently at week 6 so that the progression of the autonomic function could be evaluated over that period of time. The collected data were thereafter analyzed using STATA/SE version 16.1 (StataCorp). The Fisher Exact test, McNemar exact test, Mann-Whitney test and Wilcoxon test were used for data analysis. 32.4% of the participants in the healthy group were males (n = 12) and 67.6% were females (n = 25). Participants' age ranged from 33 years old to 76 years old with the majority being 40-60 years of age (62.1%) (Mean age 52.4 SD = 11.4). Heart rate variability (HRV) in response to Valsalva Maneuver, metronome breathing, standing and sustained handgrip in the infection group was lower than in the healthy group throughout the weeks. Moreover, both the HRV in response to metronome breathing and standing up showed a statistically significant difference when the mean values were compared between both groups in week 1 (p = 0.03 and p = 0.013). The prevalence of CAD was significantly higher in the infection group compared to healthy volunteers, both at the beginning of the study (p = 0.018) and at the end of follow up (p = 0.057), when all patients had been discharged. CAD, as assessed by the HRV, is a common finding during the recovery period of a bacterial infection, even after 6 weeks post-hospital admission. This may increase the risk of complications and cardiovascular instability. It may therefore be of value to conduct a wider scale study to further evaluate this aspect so recommendations can be made for the cardiovascular autonomic assessment of patients while they are recovering from a bacterial infectious process.

Evaluation of peripheral and autonomic nervous systems dysfunctions in patients with Parkinson’s disease

BackgroundPeripheral neuropathy (PN) is increasingly recognized in Parkinson’s disease (PD). This study aimed to evaluate peripheral nerve and autonomic nervous system dysfunction in PD. Forty patients with PD (20 drug-naïve, 20 on treatment) and 20 controls underwent neurological examination, Toronto Clinical Neuropathy Score (TCNS), nerve conduction studies, autonomic function tests including (heart rate variability, Blood pressure changes with standing and sustained handgrip, and sudomotor pathways. The Ewing classification system scored each test to quantify autonomic failure severity). Laboratory tests (B12, homocysteine, methylmalonic acid).ResultsTreated patients with PD had higher MDS-UPDRS scores than drug-naïve (p = 0.001). TCNS indicated mild PN in some drug-naïve patients, and mild–moderate PN in treated patients. Nerve conduction studies showed significant sensory and motor neuropathy in treated versus drug-naïve PD and controls. Treated patients had lower B12, higher homocysteine/methylmalonic acid than other groups. Across autonomic tests, controls had the most normal results, followed by drug-naïve patients, with treated patients being most abnormal. Autonomic dysfunction correlated with disease duration, severity, L-dopa dose. Lower B12, higher homocysteine/methylmalonic acid levels were associated with greater neuropathy and disease severity.ConclusionPatients with PD show evidence of PN and autonomic dysfunction, which is milder in drug-naïve patients but worsens with disease progression and treatment. Peripheral nervous system assessments may help diagnose and monitor PD neuropathy and effects of interventions.

Distribution of Cardiovascular Dysautonomia Pattern across Different Stages of Chronic Kidney Disease

Context: Autonomic dysfunction (AD) brings up cardiovascular morbidity/mortality and has been reported in chronic kidney disease (CKD). Still, the pattern of AD in CKD is elusive. Aim: To evaluate the distribution of cardiovascular dysautonomia in CKD. Material and Methods: This study was conducted on 33 CKD cases and 30 age and sex matched healthy controls. Five standard autonomic function tests were conducted, namely, heart rate response to Valsalva maneuver, deep breathing, and standing, and BP response to standing and sustained handgrip; based on which the patients were classified as normal, or having early parasympathetic, definite parasympathetic and combined damage. The total autonomic function score was also calculated. Results: All cases belonged to CKD stages of 3, 4, and 5; and came up with autonomic failure. The mean total autonomic function score was higher (P &lt; 0.001) in CKD (5.09 ± 2.33) as compared to the control group (0.97 ± 0.24), using the unpaired “t” test. Most of the CKD patients (45.45%) were involved with combined damage. Of the three stages, combined damage struck stage 5 to the maximum extent (63.63%). Sympathetic failure always co occurred with parasympathetic failure. Conclusion: Combined autonomic failure is more conspicuous in late CKD, predominantly occurring in stage 5. The disease course may contort the parasympathetic system before the sympathetic system.

Household food insecurity is associated with greater autonomic dysfunction testing score in Latinos with type 2 diabetes.

We examined household food insecurity (HFI) and autonomic nervous system (ANS) function in a subset of low-income Latinos with type 2 diabetes with data from a stress management trial. InclusionLatino or Hispanic, Spanish speaking, age less than 18 years, ambulatory status, type 2 diabetes more than 6 months, A1c less than 7.0%. ExclusionPain or dysfunction in hands (e.g., arthritis) precluding handgrip testing; medical or psychiatric instability. HFI was assessed with the 6-item U.S. household food security survey module; with responses to > = 1 question considered HFI. An ANS dysfunction index was calculated from xix autonomic function tests which were scored 0 = normal or 1 = abnormal based on normative cutoffs and then summed. Autonomic function tests were: 1) 24-hour heart rate variability as reflected in standard deviation of the normal-to-normal (SDNN) heart rate acquired with 3-channel, 7-lead ambulatory electrocardiogram (Holter) monitors; 2) difference between the highest diastolic blood pressure (DBP) during sustained handgrip and the average DBP at rest; 3) difference between baseline supine and the minimal BP after standing up; and, from 24-hour urine specimens 4) cortisol, 5) normetanephrine, and, 6) metanephrine. Thirty-five individuals participated, 23 (65.7%) of them were women, age mean = 61.6 (standard deviation = 11.2) years, HbA1c mean = 8.5% (standard deviation = 1.6) and 20 participants (57.1%) used insulin. Twenty-two participants (62.9%) reported HFI and 25 (71.4%) had one or more abnormal ANS measure. Independent t-tests showed that participants with HFI had a higher ANS dysfunction index (mean = 1.5, standard deviation = 0.9) than patients who were food secure (mean = 0.7, standard deviation = 0.8), p = 0.02. Controlling for financial strain did not change significance. Total ANS index was not related to glycemia, insulin use or other socioeconomic indicators. In this sample, HFI was associated with ANS dysfunction. Policies to improve food access and affordability may benefit health outcomes for Latinos with diabetes.

Comparison of cardiovascular autonomic functions between type 2 diabetes mellitus patients and healthy individuals

Background: Type 2 diabetes mellitus is increasing day by day across the world. Cardiac autonomic neuropathy (CAN) is the most overlooked but the most debilitating complication of diabetes mellitus. If the chance of a diabetic patient to develop CAN in the future is diagnosed at an early stage of the disease, proper measures can be suggested which will delay the development of the complication. Aim and Objectives: The aim and objective of the study are to compare the cardiovascular autonomic functions between type 2 diabetes mellitus patients and normal individuals and to find whether cardiac autonomic neuropathy is present in type 2 diabetes mellitus patients. Materials and Methods: This cross-sectional study included 80 male individuals. Study participants were selected from patients attending diabetic clinics based on the inclusion criteria. A total of 80 subjects were selected out of which 40 were diabetic group and 40 were normal individuals. Cardiac autonomic functions were assessed using heart rate response to a change in posture and during the Valsalva maneuver, blood pressure response to a change in posture and during sustained isometric handgrip and heart rate variability (HRV) measurements were done using Kubios HRV analyzer software version 1.1. Results: Results were analyzed using IBM SPSS version 20 software. It was found that the resting systolic and diastolic blood pressure was found to have statistically significant higher values in the diabetic group. The mean and standard deviation of the Valsalva ratio were found to have statistically significant higher values in the diabetic group. The frequency domain parameters of HRV showed significant sympathetic predominance in the diabetic group. Conclusion: The need for early identification of cardiac autonomic neuropathy by various tests as well as the importance of lifestyle modifications were emphasized among all the participants of the study.

Evaluation of the autonomic nervous system in patients with essential tremor

BackgroundEssential tremor (ET) is a prevalent movement disorder that may be linked to neurodegenerative changes. It is marked by a mix of motor and non-motor symptoms, which include disturbances in the autonomic nervous system. Aim of the study: We aimed to assess autonomic dysfunction in individuals with essential tremor. Thirty patients with essential tremor (Group 1) and 30 age and sex-matched healthy subjects as the control group (Group 2) were recruited. Comprehensive medical and neurological examinations were conducted on all participants, followed by electrophysiological assessments of autonomic function, including heart rate variability (HRV) tests (E/I ratio, Valsalva ratio, 30:15 ratio), adrenergic tests (blood pressure responses to active standing and sustained hand grip), and sympathetic skin response (SSR) tests. Finally, the results of these tests were classified according to the Ewing classification of autonomic failure. Results: The study revealed significant differences between ET patients and the control group. Heart rate variability tests showed a marked difference between the groups. Adrenergic tests, measuring sympathetic innervation, also displayed a significant difference. The sudomotor function test exhibited noteworthy differences in onset latencies and amplitudes in the palm and sole, with ET patients showing prolonged onset latencies and decreased amplitudes. Moreover, the study found a significant correlation between disease severity and autonomic function test results and the Ewing score. Conclusion: The study highlights the presence of autonomic dysfunction in essential tremor patients, with disease severity being associated with the level of autonomic affection, as evidenced by various autonomic function tests and the Ewing score.

Abstract 16194: Relationship Between Change in Global Longitudinal Strain and Sustained Handgrip Induced Afterload as Assessed Using Invasive Left Ventricular Pressure Measurements and Machine Learning Analytics

Introduction: Global longitudinal strain (GLS) is a sensitive, quantitative measure of left ventricular (LV) systolic function and affected by afterload. We sought to compute the impact of LV systolic pressure (LVP) increase on GLS using handgrip stress during invasive LVP measurements. Methods: Patients undergoing left heart catheterization (n=51; mean age 64+/-11 years; 31% women; Table) for standard of care indications underwent echocardiography during handgrip stress with a catheter in the LV cavity. GLS and LVP were measured simultaneously over 15 seconds of continuous handgrip. GLS and LVP relationships were analyzed using linear regression and machine learning methods. Results: Sustained handgrip (HG) stress significantly increased LVP and reduced GLS. There was no significant correlation between resting and peak HG stress LVP and GLS (p= 0.32 &amp; 0.36, respectively). However, change in GLS was significantly correlated with change in LVP (p&lt;0.0001; Figure) with every 10 unit increase in LVP associated with a 0.6 reduction in GLS. The penalized maximum likelihood machine learning method was used to select key factors associated with the within subject slope of % change in GLS over % change in LVP (median slope -0.53; IQR-0.91 to -0.29). LV ejection fraction was identified as an important predictor of the GLS-LVP slope. LV ejection fraction was significantly associated with the slope (p=0.0005; Figure) with a 10 unit increase in LV ejection fraction corresponding to 0.22 increase in the slope. Conclusions: LV afterload is associated with significant decrements in GLS. LV ejection fraction is an important predictor of the GLS-LVP slope. These data provide the foundation to build models that would account for change in LVP during serial measurements of GLS thus allowing reliable comparison of repeated GLS measurements.

Physical exercise and cardiovascular response: design and implementation of a pediatric CMR cohort study

To examine feasibility and reproducibility and to evaluate the cardiovascular response to an isometric handgrip exercise in low-risk pediatric population using Cardiovascular Magnetic Resonance measurements. In a subgroup of 207 children with a mean age of 16 years participating in a population-based prospective cohort study, children performed an isometric handgrip exercise. During rest and exercise, continuous heart rate and blood pressure were measured. Cardiovascular magnetic resonance (CMR) measurements included left ventricular mass, aortic distensibility and pulse wave velocity at rest and left ventricular end-diastolic and end-systolic volumes, ejection fraction, stroke volume and cardiac output during rest and exercise. 207 children had successful CMR measurements in rest and 184 during exercise. We observed good reproducibility for all cardiac measurements. Heart rate increased with a mean ± standard deviation of 42.6% ± 20.0 and blood pressure with 6.4% ± 7.0, 5.4% ± 6.1 and 11.0% ± 8.3 for systolic, diastolic and mean arterial blood pressure respectively (p-values < 0.05). During exercise, left ventricular end-diastolic and end-systolic volumes and cardiac output increased, whereas left ventricular ejection fraction slightly decreased (p-values < 0.05). Stroke volume did not change significantly. A sustained handgrip exercise of 7 min at 30–40% maximal voluntary contraction is a feasible exercise-test during CMR in a healthy pediatric population, which leads to significant changes in heart rate, blood pressure and functional measurements of the left ventricle in response to exercise. This approach offers great novel opportunities to detect subtle differences in cardiovascular health.

Comparable Neuromuscular Function During Sustained Isometric Handgrip Muscle Fatigue In Men And Women

Comparable Neuromuscular Function During Sustained Isometric Handgrip Muscle Fatigue In Men And Women

An insight into gender based variations of autonomic functions among young adults

Since this is a vital developmental phase, studying the health patterns of young adults, particularly cardiovascular health, is critical. Autonomic function testing (AFT) is a crucial non-invasive procedure for determining the state of one's cardiovascular system. There are only a few studies on autonomic responsiveness in young people. To study the autonomic responses to various cardiovascular autonomic function tests among young adult subjects and to look into the gender-based variations.Males made up 114 (50.67 percent) of the total 225 individuals, while females made up the rest. The study's target age group was 18-29 years old. The CANWIN analyser of genesis medical systems was used to investigate autonomic function tests such as resting heart rate, heart rate reaction to slow deep breathing (SDB), Valsalva Ratio (VR), 30:15 ratios response to standing, and blood pressure response to sustained handgrip. CANWIN is a state-of-the-art Cardiac Autonomic Neuropathy (CAN) Analysis System with interpretation for PC Windows*. The data was analysed statistically using STATA software (version 13.1).: Dysautonomia was seen in 150 of the 225 participants (66.66 percent). The number of dysautonomia participants was not statistically different between males and females (P value=0.15).: Anxiety, stress, a poor diet, and a disrupted sleep cycle could all contribute to the high number of dysautonomia patients. There have been a number of reports linking dysautonomia to nutritional deficits. To investigate the causative factors, more longitudinal studies including nutritional status assessments are needed.

Analysis of the force–time curve and median frequency of surface electromyographic signals during isometric hand grip test for estimation of a temporal pattern for muscle strengthening

This work presents methods developed for the analysis of dynamometric and electromyographic signals acquired during sustained maximal isometric hand grip tasks. In these analyses, we try to find a temporal pattern that could indicate the beginning of the decrease in hand grip strength. This information is essential for choosing the best isometric activity time for hand rehabilitation. The technique applied to the dynamometric signal was to find the time interval that precedes the drop of the isometric force RMS (root mean square) curve to values lower than the effective value. The technique applied to the surface electromyography (sEMG) signals was the identification of the instant when the lowest value of the median frequency of the signal occurs. The dynamometry data collection was carried out bilaterally in 19 men and 21 women. The electromyography data collection was carried out bilaterally in only 19 women. The statistical results (5% significance level) for the dynamometry data indicated that the time from the beginning of the test to the beginning of the decay of strength was approximately 7.6 $$\pm$$ 3.2 s, while the results for the sEMG data indicated that the time from the beginning of the test to the appearance of the lowest value of the median frequency was approximately 10.1 $$\pm$$ 2.9 s. The method of using the RMS values of the Force, presented by this work, found results of approximately 7 s, while the method most currently used (Median Frequency) found values of approximately 10 s. These results may help the rehabilitation professional to decide with more security the isometric time of exercises.

Increased pupil and heart-rate responses to sexual stimuli in men after physical exertion.

Physical stress has been found to enhance arousability by visual sexual stimuli on a short-term basis, as reflected in higher phasic pupil dilation responses, probably mediated by sympathetic nervous system (SNS)-related processes. However, previous research has not addressed the specificity of this effect in terms of emotional valence, that is, whether it reflects an instance of general excitation transfer or a more specific mechanism. Thus, to further investigate changes in sexual processing after acute stress exposure, 40 male participants underwent either a predominantly sympathetic stressor (3min sustained handgrip) or similar control procedure. After stress induction, pictures varying in valence as well as sexual versus non-sexual arousal were presented (for 5000 ms each). Using principal component analysis, pupillary responses during picture viewing were dissociated into fast and slow components (early vs. late response phases). In addition, startle eyeblink responses were elicited by bursts of white noise (50 ms, 105 dB) in half of the trials and recorded at the orbicularis oculi via electromyography. Skin conductance and heart rate were co-registered, as well. While affective startle modulation and skin conductance responses to emotional stimuli were unaffected by previous stress exposure, both evoked heart-rate deceleration (but not acceleration) and pupil responses were specifically enhanced with sexually arousing stimuli in stressed participants, and this effect was mediated by blood pressure reactivity as an index of preceding SNS activation. Taken together, our findings provide strong evidence for enhancement of sexual processing by acute stress exposure in men and suggest differential involvement of parasympathetic versus sympathetic mechanisms.

S-45-4: THE EFFECTS OF HANDGRIP STRESS TEST ON HEMODYNAMIC PARAMETERS IN PATIENTS WITH HYPERTENSION AND DIASTOLIC HEART FAILURE

Aim: The effectiveness of isometric handgrip exercise on changes of cardiovascular hemodynamic parameters in patients with diastolic heart failure is unknown. We assess the effect of several hemodynamic parameters and it changes during handgrip maneuvers in patients with arterial hypertension and diastolic heart failure during different stages of chemotherapy. Methods: The study population included 245 patients females /120 pts with HFpEF and 100 pts with HFmrEF and 25 pts with HFnEF / mean age of 45 years/. The effects of handgrip maneuver on hemodynamic parameters were studied by speckle tracking echocardiography. Following maximal squeeze until 100%, during the next 3 minutes patients were instructed to apply pressure at 50 %. The global longitudinal strain were extracted by 3, 4 and 2 CV images 70 fr/s and MAP and HR were performed at basal level, 1st, 2nd and 3rd minutes during handgrip stress test. Results: Heart rate (HR) and mean arterial pressures (MAP) increased significantly after handgrip maneuver (from 95 beats/min to 101 beats/min; from 109 mm Hg to 118 mm Hg, p &lt; 0.05 respectively). Pulmonary capillary wedge pressure (PCWP), pulmonary artery systolic (s) and diastolic (d) pressures (PAP), cardiac index (CI), left ventricular ejection fraction (LVEF), did not change after handgrip maneuvers (p &gt; 0.05). On the other hand, PAPs and PAPd, MAP and HR (p &lt; 0.05) decreased significantly during handgrip maneuvers in group with HFmrEF. In same group were found significantly decreases of GLVLS at 2nd and 3rd minutes during stress test comparable with other 2 groups / p &lt; 0.01/ Conclusion: Cardiovascular response to handgrip maneuver may be a marker of failure to respond to compensatory mechanisms. Patients with good LV reserve had a rise in stroke /work with little or no change in LVEDP. Patients with poor reserve had a fall in stroke/ work together with a substantial rise in LVEDP. It is concluded that the stress imposed by sustained handgrip provides a simple test for the evaluation of left ventricular reserve in patients, who will develop cardiotoxicity during chemotherapy treatment.

Cardiac Autonomic Neuropathy in Prediabetes: A Case-Control Study.

Early detection and diagnosis of diabetic autonomic neuropathy, especially cardiac autonomic neuropathy (CAN), have gained attention recently because of their elevated cardiovascular mortality risk. Although the connection between type 2 diabetes mellitus and autonomic neuropathy is well established, evidence is emerging that the association might predate the stage of prediabetes. The present study was undertaken to compare the prevalence of CAN in prediabetes versus that in normoglycemic controls. The study population was selected by purposive sampling from individuals attending a tertiary care hospital from January 2018 to June 2019. Fifty individuals with prediabetes diagnosed by the American Diabetes Association's glycated haemoglobin criteria and 50 age- and gender-matched healthy controls were recruited. CAN was assessed by standard cardiovascular reflex tests, as described by Ewing and Clarke. Changes in R-R with deep breathing, Valsalva manoeuver, and changes in blood pressure (BP) in response to standing and sustained handgrip were evaluated. Three-time domains [standard deviation of normal-to-normal intervals (SDNN), root mean square of successive RR intervals (rMSSD) and percentage of successive normal to normal R-R (NN) intervals that differ by more than 50 ms (pNN50)] and four frequency domain indices [very low-frequency band (VLF), low-frequency band (LF), high-frequency band (HF), LF/HF ratio) of heart rate variability (HRV)] were examined. The mean heart rate was 71.37 ± 7.94 and 65.59 ± 8.73 beats/min in patients with prediabetes and controls, respectively (P < 0.05). All three-time-domain indices of HRV were significantly lower in persons with prediabetes compared to controls. The peak frequency of LF, peak power of LF, normalised unit of LF, and LF/HF ratio was significantly lower in subjects with prediabetes than in controls. There was no difference in the traditional cardiovascular autonomic reflex testing. Our study demonstrates the presence of subclinical autonomic dysfunction in persons with prediabetes. Early detection of CAN in prediabetes can have future implications for cardiovascular risk reduction.

PS-C14-2: QUANTITATIVE METHODS FOR ASSESSING CONTRACTILE RESERVE IN PATIENTS WITH DIASTOLIC HEART FAILURE

Aim: The effectiveness of isometric handgrip exercise on changes of cardiovascular hemodynamical parameter in patients with diastolic heart failure is unknown. We assessed the effect of several hemodynamic parameters and it changes during handgrip maneuvers in patients with different stages of diastolic heart failure during chemotherapy and their improvements after 4 months follow up (4mFU) treatment with single pill combination of ACE inhibitor ACE) and beta blocker(BB). Methods: The study population included 65 patients female / mean age of 45 ± 12 years/ 55 with breast cancer and undergoing chemotherapy / 30 pts with HFpEF and 25 pts with HFmrEF / and 10 pts with HFnEF and without chemotherapy. The effect of handgrip maneuver on hemodynamic parameters were studied by speckle tracking echocardiography. Following maximal squeeze by 100%, during the next 3 minutes patients were instructed to apply pressure at 50%. The global longitudinal strain were extracted by 3, 4 and 2 chamber apical view images on 70 fr/s and MAP and HR were performed at basal level, 1st, 2nd and 3rd minutes during handgrip stress test. The contractility /force/ of LV were also calculate as ratio SBP / ESV. Patients with HFmrEF and HFpEF received for 4 months treatment with single pill combination ACE (perindorpril)/ BB (bisoprolol) 5/5 mg. Results: Heart rate(HR) and mean arterial pressure(MAP) increased significantly after handgrip maneuver / from 75 ± 6 beats /min to 101 ± 12 beats/ min, 109 ± 15 mmHg to 118 ± 19mmHg, p &lt; 0,05 /. Pulmonary artery systolic(s) and diastolic (d) pressure(PAP),pulmonary capillary wedge pressure (PCWP), cardiac index(CI), LVEF did not change significantly(p &gt; 0,5) after handgrip maneuvers. On the other hand, LV force (SBP/ ESV ratio),MAP and HR decreases significantly (p &lt; 0,01) in group with HFmrEF. In same group were found significantly decreased GLVLS at 2nd and 3rd minutes during stress- test comparable with other 2 groups with HFpEF and HFnEF. After 4mFU and treatment with 5/5 mg doses combination of ACE / BB were found improvement in parameters: HR /p &lt; 0,001/, MAP /p &lt; 0.01/ and contractile reserve as well as LV force /p &lt; 0, 01/ and GLVLS /p &lt; 0,001/. Conclusion: Cardiovascular response to handgrip maneuver may be a marker of failure to respond to compensatory mechanisms. Patients with good LV reserve had a rise in stroke work with little or no change in LVEDP. Patients with poor contractile reserve had a fall in stroke work reserve together with a substantial rise in LVEDP. It is concluded that the stress imposed by sustained handgrip provides a simple test for evaluation of LV contractile reserve in patients, who will develop cardiotoxicity during chemotherapy treatment. The treatment with combination with small doses ACE/BB is a big challenge in patients with HFmrEF and HFpEF to improve the contractile reserve.

Association of Cardiac Autonomic Function Derangement with Obesity and Glycated Haemoglobin: A Cross-sectional Study

Introduction: Hyperglycaemia (as assessed by Glycated haemoglobin (HbA1c)) and obesity lead to the production of advanced glycation end products in blood, which are responsible for damage to the microvasculature, slowly leading to cardiac autonomic dysfunction. Thus, chronic prediabetic hyperglycaemia, as measured by HbA1c may affect cardiac autonomic function in different ranges of obesity (overweight and obese). Aim: To study the association of cardiac autonomic dysfunction with Body Mass Index (BMI) and HbA1c. Materials and Methods: The cross-sectional study was conducted at BPS Government Medical College, Sonepat, Haryana, India, from June to December 2019. This study included age and sex-matched 50 healthy, 50 overweight, and 50 obese subjects aged 18-50 years. Serum HbA1c, lipid profile and cardiac autonomic function tests for the parasympathetic system (Resting heart rate, Expiration-inspiration difference on deep breathing, Heart rate response to standing/30:15 stand ratio, Valsalva ratio) and sympathetic system {postural hypotension/fall in Systolic Blood Pressure (SBP) and change in Diastolic Blood Pressure (DBP) on sustained hand grip test} were performed. Chi-square test and Mann-Whitney test were used for statistical analysis. Results: The prevalence of sympathetic autonomic dysfunction was highest in the obese group (36% in males n=25, and 32% in females, n=25) followed by overweight group (12% in males, n=25 and 12% in females, n=25). The prevalence of parasympathetic autonomic dysfunction was highest in the obese group (40% in males, n=25 and 32% in females, n=25), followed by the overweight group (24% in males, n=25 and 16% in females, n=25). Further, HbA1c was highest in obese males (6.27±1.54) and females (5.94±0.45), followed by overweight males (5.89±0.92) and females (5.46±1.84). Males and females with autonomic dysfunction had significantly higher HbA1c (Males 6.4±0.42 and Females 6.2±0.38) than those without it (Males 5.4±0.86 and Females 5.2±0.75) in the obese and overweight groups taken together. Conclusion: The prevalence of parasympathetic and sympathetic dysfunction is incrementally increased with higher obesity (BMI) and HbA1c. Overweight and obese subjects with cardiac autonomic dysfunction had higher HbA1c and worse lipid profiles than overweight and obese subjects without autonomic dysfunction.

Effects of α-lactalbumin on strength, fatigue and psychological parameters: a randomised double-blind cross-over study.

The neurotransmitter serotonin has a strong effect on behaviour and motor control. Regarding motor control, serotonin contributes to the development of fatigue and is also involved in the ability of motor neurones to operate across a large range of forces (gain control). The consumption of tryptophan-rich supplements (such as α-lactalbumin) is of interest because this amino acid is the only precursor for brain serotonin synthesis. Therefore, the purpose of this study was to determine the effects of α-lactalbumin supplementation on neuromuscular performance. Using a randomised double-blind cross-over design, 16 healthy participants performed plantar flexor and handgrip maximal voluntary contractions, a 30-s submaximal handgrip contraction, and a plantar flexor fatigue protocol before and 90min after consuming either 40g of α-lactalbumin, an isonitrogenous beverage (Zein) or an isocaloric beverage (corn-starch). Sleepiness, mood, and cognition were assessed to evaluate any psychological effects. α-Lactalbumin decreased force steadiness by 25% during the sustained submaximal handgrip contraction (p < 0.01) and induced greater fatigue (15% reduction in total torque-time integral, p = 0.01) during the fatigue protocol. These effects were not observed for the other control beverages. No effects were found for maximal or explosive strength, or psychological measurements. 40g of α-lactalbumin increased handgrip force variability and reduced performance during fatiguing muscle contractions but did not influence brief maximal contractions or psychological parameters in healthy individuals. These findings support the hypothesis that the consumption of α-lactalbumin can increase motor neurone input-output gain and exacerbate central fatigue during sustained maximal exercise.

INvesTigating the Abnormality of detrusor ConTractility by uroflowmetry in diabetic children (INTACT Trial): protocol of a prospective, observational study

IntroductionBladder emptying abnormalities and cardiovascular autonomic dysfunction are manifestations of autonomic dysfunction in people with diabetes mellitus (DM), which are major causes of morbidity and mortality. Since they can reduce...