Cardiovascular pathophysiology from the cardioneural perspective and its clinical applications

Shah, Amit; Wittbrodt, Matthew T.; Bremner, J. Douglas; Vaccarino, Viola

doi:10.1016/j.tcm.2021.03.001

Cited by 15 publications

(17 citation statements)

References 50 publications

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“…Even more compellingly, a recent meta-analysis found a significant decrease in SDNN for individuals with chronic pain compared to healthy controls ( 46 ). These negative correspondences agree with those shown in the context of stress, depression, and heart disease ( 47 – 49 ). Across these fields, HRV decreases are generally considered unfavorable.…”

Section: Discussionsupporting

confidence: 88%

Pain is reduced by transcutaneous cervical vagus nerve stimulation and correlated with cardiorespiratory variability measures in the context of opioid withdrawal

Gazi

Harrison²,

Lambert³

et al. 2022

Front. Pain Res.

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Over 100,000 individuals in the United States lost their lives secondary to drug overdose in 2021, with opioid use disorder (OUD) being a leading cause. Pain is an important component of opioid withdrawal, which can complicate recovery from OUD. This study's objectives were to assess the effects of transcutaneous cervical vagus nerve stimulation (tcVNS), a technique shown to reduce sympathetic arousal in other populations, on pain during acute opioid withdrawal and to study pain's relationships with objective cardiorespiratory markers. Twenty patients with OUD underwent opioid withdrawal while participating in a two-hour protocol. The protocol involved opioid cues to induce opioid craving and neutral conditions for control purposes. Adhering to a double-blind design, patients were randomly assigned to receive active tcVNS (n = 9) or sham stimulation (n = 11) throughout the protocol. At the beginning and end of the protocol, patients' pain levels were assessed using the numerical rating scale (0–10 scale) for pain (NRS Pain). During the protocol, electrocardiogram and respiratory effort signals were measured, from which heart rate variability (HRV) and respiration pattern variability (RPV) were extracted. Pre- to post- changes (denoted with a Δ) were computed for all measures. Δ NRS Pain scores were lower (P = 0.045) for the active group (mean ± standard deviation: −0.8 ± 2.4) compared to the sham group (0.9 ± 1.0). A positive correlation existed between Δ NRS pain scores and Δ RPV (Spearman's ρ = 0.46; P = 0.04). Following adjustment for device group, a negative correlation existed between Δ HRV and Δ NRS Pain (Spearman's ρ = −0.43; P = 0.04). This randomized, double-blind, sham-controlled pilot study provides the first evidence of tcVNS-induced reductions in pain in patients with OUD experiencing opioid withdrawal. This study also provides the first quantitative evidence of an association between breathing irregularity and pain. The correlations between changes in pain and changes in objective physiological markers add validity to the data. Given the clinical importance of reducing pain non-pharmacologically, the findings support the need for further investigation of tcVNS and wearable cardiorespiratory sensing for pain monitoring and management in patients with OUD.

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Section: Discussionsupporting

confidence: 88%

Pain is reduced by transcutaneous cervical vagus nerve stimulation and correlated with cardiorespiratory variability measures in the context of opioid withdrawal

Gazi

Harrison²,

Lambert³

et al. 2022

Front. Pain Res.

Self Cite

View full text Add to dashboard Cite

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“…This likely drove the superior performance of the TEA versus CEA in differentiating participants by PTSD status, stress versus rest states, and active versus sham tcVNS. This is particularly significant for PTSD participants in active versus sham tcVNS analysis, where active tcVNS stimulates the afferent vagus, and then, through the mechanisms in the brain stem, decreases the SNS activity resulting in an increase in PEP (Gurel, Wittbrodt, et al, 2020; Shah et al, 2021). Overall, our findings suggest that careful examination and removal of noisy ICG waveforms are critical in psychophysiology research involving PEP and that such methods should be the standard for ICG signal processing of noise‐prone ambulatory data moving forward.…”

Section: Discussionmentioning

confidence: 99%

Validation of a new impedance cardiography analysis algorithm for clinical classification of stress states

et al. 2022

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Pre‐ejection period (PEP) is an index of sympathetic nervous system activity that can be computed from electrocardiogram (ECG) and impedance cardiogram (ICG) signals, but sensitive to speech/motion artifact. We sought to validate an ICG noise removal method, three‐stage ensemble‐average algorithm (TEA), in data acquired from a clinical trial comparing active versus sham non‐invasive vagal nerve stimulation (tcVNS) after standardized speech stress. We first compared TEA's performance versus the standard conventional ensemble‐average algorithm (CEA) approach to classify noisy ICG segments. We then analyzed ECG and ICG data to measure PEP and compared group‐level differences in stress states with each approach. We evaluated 45 individuals, of whom 23 had post‐traumatic stress disorder (PTSD). We found that the TEA approach identified artifact‐corrupted beats with intraclass correlation coefficient > 0.99 compared to expert adjudication. TEA also resulted in higher group‐level differences in PEP between stress states than CEA. PEP values were lower in the speech stress (vs. baseline rest) group using both techniques, but the differences were greater using TEA (12.1 ms) than CEA (8.0 ms). PEP differences in groups divided by PTSD status and tcVNS (active vs. sham) were also greater when using the TEA versus CEA method, although the magnitude of the differences was lower. In conclusion, TEA helps to accurately identify noisy ICG beats during speaking stress, and this increased accuracy improves sensitivity to group‐level differences in stress states compared to CEA, suggesting greater clinical utility.

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“…Abnormal HRV is also associated with chronic stress factors such as PTSD and depression [ 8 •]. Noninvasive measures such as cardiac impedance-derived pre-ejection period are also used to determine the impact of stress on myocardial physiology (Table 1 ) [ 38 , 39 ]. A major area of emerging investigation is the role of neural and autonomic reactivity and triggering of the inflammatory process (see the “ Brain Correlates of Angina and Mental Stress Ischemia ” section below) [ 40 ].…”

Section: Stress Physiologymentioning

confidence: 99%

Mental Stress-Induced Myocardial Ischemia

et al. 2022

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Purpose of Review To summarize recent evidence on mental stress-induced myocardial ischemia (MSIMI), its mechanisms, and clinical significance. Recent Findings MSIMI can occur in patients with normal cardiac stress testing, is only weakly related to severity of coronary artery disease (CAD), and it is often silent. Among patients with CAD, MSIMI is associated with a twofold increased risk of major adverse cardiovascular events compared to those who do not have MSIMI. Certain groups such as young women with myocardial infarction and those with psychological comorbidities are more susceptible to MSIMI. Abnormal microvascular vasoreactivity and inflammation are implicated mechanisms in MSIMI. Increased brain activity in regions that modulate autonomic reactivity to emotional stress and fear is associated with MSIMI. Summary MSIMI has important prognostic implications in patients with CAD. Stress can no longer be ignored as a risk factor in cardiology care. Clinical trials testing effective strategies to target MSIMI are needed.

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Cardiovascular pathophysiology from the cardioneural perspective and its clinical applications

Cited by 15 publications

References 50 publications

Pain is reduced by transcutaneous cervical vagus nerve stimulation and correlated with cardiorespiratory variability measures in the context of opioid withdrawal

Pain is reduced by transcutaneous cervical vagus nerve stimulation and correlated with cardiorespiratory variability measures in the context of opioid withdrawal

Validation of a new impedance cardiography analysis algorithm for clinical classification of stress states

Mental Stress-Induced Myocardial Ischemia

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