Autonomic Nervous System and Neurocardiac Physiopathology

Kingma, John G.; Simard, Denys; Rouleau, Jacques R.

doi:10.5772/intechopen.77087

Cited by 6 publications

(4 citation statements)

References 201 publications

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“…Initially, we anticipated that the relevance in the AMI group would be highest, but our findings unexpectedly showed a high relevance in the UAP and chronic HF groups instead. The reason for this is that although norepinephrine is released from sympathetic nerves in AMI, it triggers sympathetic nerve remodeling to promote sympathetic hyperinnervation, therefore the direct influence of the changes in the glucose levels on autonomic nervous system was reduced, resulting in a weak correlation in patients with AMI ( 25 ). For this reason, the influence of changes in blood sugar values on autonomic nervous system was lower in the AMI group than in the other two groups.…”

Section: Discussionmentioning

confidence: 99%

Association between Changes in the Systolic Blood Pressure from Evening to the Next Morning and Night Glucose Variability in Heart Disease Patients

et al. 2021

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Aims To assess the impact of glycemic variability on blood pressure in hospitalized patients with cardiac disease. Methods In 40 patients with cardiovascular disease, the glucose levels were monitored by flash continuous glucose monitoring (FGM; Free-Style Libre™ or Free-Style Libre Pro; Abbott, Witney, Oxfordshire, UK) and self-monitoring blood glucose (SMBG) for 14 days. Blood pressure measurements were performed twice daily (morning and evening) at the same time as the glucose level measurement using SMBG. Results The detection rate of hypoglycemia using the FGM method was significantly higher than that with the 5-point SMBG method (77.5% vs. 5.0%, P<0.001). Changes in the systolic blood pressure from evening to the next morning (morning -evening [ME] difference) were significantly correlated with night glucose variability (r=0.63, P<0.001). A multiple regression analysis showed that night glucose variability using FGM was more closely correlated with the ME difference (r=0.62 [95% confidence interval, 0.019-0.051]; P< 0.001) than with the age, body mass index, or smoking history. Night glucose variability was also more closely associated with the ME difference in patients with unstable angina pectoris (UAP) than in those with acute myocardial infarction (AMI) or heart failure (HF) (r=0.83, P=0.058). Conclusion Night glucose variability is associated with the ME blood pressure difference, and FGM is more accurate than the 5-point SMBG approach for detecting such variability.

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Section: Discussionmentioning

confidence: 99%

Association between Changes in the Systolic Blood Pressure from Evening to the Next Morning and Night Glucose Variability in Heart Disease Patients

et al. 2021

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“…The brain–heart axis is a well‐established and evolutionarily conserved circuit connecting frontal brain regions to the autonomic nervous system via limbic (i.e., amygdala), hypothalamic, and brainstem structures. Projections from the PFC extend to the insula and cingulate cortex, which project to both the amygdala and hypothalamus, which then project to the solitary nucleus and rostral ventrolateral medulla in the brainstem, regulating HR through sympathetic and parasympathetic projections to the sinoatrial node (the heart's endogenous pacemaker; Kingma et al, 2018). The solitary nucleus is also a critical hub for integrating bottom up (afferent) inputs from baroreceptors within the carotid bodies and vagal afferents.…”

Section: The Brain–heart Axismentioning

confidence: 99%

Involvement of the brain–heart axis in the link between PTSD and cardiovascular disease

Seligowski

Webber

Marvar

et al. 2022

Depression and Anxiety

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Posttraumatic stress disorder (PTSD) has long been associated with a heightened risk of cardiovascular disease (CVD). A number of mechanisms have been implicated to underlie this brain-heart axis relationship, such as altered functioning of the autonomic nervous system and increased systemic inflammation. While neural alterations have repeatedly been observed in PTSD, they are rarely considered in the PTSD-CVD link. The brain-heart axis is a pathway connecting frontal and limbic brain regions to the brainstem and periphery via the autonomic nervous system and it may be a promising model for understanding CVD risk in PTSD given its overlap with PTSD neural deficits. We first provide a summary of the primary mechanisms implicated in the association between PTSD and CVD. We then review the brain-heart axis and its relevance to PTSD, as well as findings from PTSD trials demonstrating that a number of PTSD treatments have effects on areas of the brain-heart axis. Finally, we discuss sex considerations in the PTSD-CVD link. A critical next step in this study is to determine if PTSD treatments that affect the brain-heart axis (e.g., brain stimulation that improves autonomic function) also reduce the risk of CVD.

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“…2). In a recent study in a rodent model of PAH, it was shown that VNS for several weeks attenuated pulmonary vascular remodeling, preserved RV function and improved survival (Yoshida et al 2018b); it accomplished that by chronically "re-setting" the balance between sympathetic and parasympathetic reflex circuits in the periphery and in the central nervous system (Kingma et al 2018).…”

Section: Targeting Autonomic Imbalancementioning

confidence: 99%

Pulmonary arterial hypertension: the case for a bioelectronic treatment

et al. 2019

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Pulmonary arterial hypertension (PAH) is a rare disease of unknown etiology that progresses to right ventricular failure. It has a complex pathophysiology, which involves an imbalance between vasoconstrictive and vasodilative processes in the pulmonary circulation, pulmonary vasoconstriction, vascular and right ventricular remodeling, systemic inflammation, and autonomic imbalance, with a reduced parasympathetic and increased sympathetic tone. Current pharmacological treatments for PAH include several classes of drugs that target signaling pathways in vascular biology and cardiovascular physiology, but they can have severe unwanted effects and they do not typically stop the progression of the disease. Pulmonary artery denervation has been tested clinically as a method to suppress sympathetic overactivation, however it is a nonspecific and irreversible intervention. Bioelectronic medicine, in particular vagus nerve stimulation (VNS), has been used in cardiovascular disorders like arrhythmias, heart failure and arterial hypertension and could, in principle, be tested as a treatment in PAH. VNS can produce pulmonary vasodilation and renormalize right ventricular function, via activation of pulmonary and cardiac vagal fibers. It can suppress systemic inflammation, via activation of fibers that innervate the spleen. Finally, VNS can gradually restore the balance between parasympathetic and sympathetic tone by regulating autonomic reflexes. Preclinical studies support the feasibility of using VNS in PAH. However, there are challenges with such an approach, arising from the need to affect a relatively small number of relevant vagal fibers, and the potential for unwanted cardiac and noncardiac effects of VNS in this sensitive patient population.

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Autonomic Nervous System and Neurocardiac Physiopathology

Cited by 6 publications

References 201 publications

Association between Changes in the Systolic Blood Pressure from Evening to the Next Morning and Night Glucose Variability in Heart Disease Patients

Association between Changes in the Systolic Blood Pressure from Evening to the Next Morning and Night Glucose Variability in Heart Disease Patients

Involvement of the brain–heart axis in the link between PTSD and cardiovascular disease

Pulmonary arterial hypertension: the case for a bioelectronic treatment

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