Effects of bilateral lung transplantation on cardiac autonomic modulation and cardiorespiratory coupling: a prospective study

Abstract

Background Although cardiac autonomic modulation has been studied in several respiratory diseases, the evidence is limited on lung transplantation, particularly on its acute and chronic effects. Thus, we aimed to evaluate cardiac autonomic modulation before and after bilateral lung transplantation (BLT) through a prospective study on patients enrolled while awaiting transplant. Methods Twenty-two patients on the waiting list for lung transplantation (11 women, age 33 [24–51] years) were enrolled in a prospective study at Ospedale Maggiore Policlinico Hospital in Milan, Italy. To evaluate cardiac autonomic modulation, ten minutes ECG and respiration were recorded at different time points before (T0) and 15 days (T1) and 6 months (T2) after bilateral lung transplantation. As to the analysis of cardiac autonomic modulation, heart rate variability (HRV) was assessed using spectral and symbolic analysis. Entropy-derived measures were used to evaluate complexity of cardiac autonomic modulation. Comparisons of autonomic indices at different time points were performed. Results BLT reduced HRV total power, HRV complexity and vagal modulation, while it increased sympathetic modulation in the acute phase (T1) compared to baseline (T0). The HRV alterations remained stable after 6 months (T2). Conclusion BLT reduced global variability and complexity of cardiac autonomic modulation in acute phases, and these alterations remain stable after 6 months from surgery. After BLT, a sympathetic predominance and a vagal withdrawal could be a characteristic autonomic pattern in this population.

Sympatho-Vagal Dysfunction in Systemic Sclerosis: A Follow-Up Study

“…A study did not find any differences between SSc subsets [ 28 ], while two studies found a reduced HRV total power in dcSSc compared to lcSSc [ 14 , 15 ]. The reduced HRV total power should be compatible with a cardiac autonomic dysfunction from both branches of the autonomic nervous system as observed in other rheumatologic [ 29 , 30 ] and cardiopulmonary [ 31 , 32 ] diseases.…”

Cardiac autonomic control in Rett syndrome: Insights from heart rate variability analysis

“…HRV is closely regulated by the central autonomic network involving brainstem, prefrontal cortex, limbic system, and other higher-order brain structures. To note, a shift of the autonomic balance toward a sympathetic predominance has been associated with a higher risk of mortality (Tsuji et al, 1996;Malliani and Montano, 2002), and highlighted as a prognostic marker of adverse clinical outcome in cardiopulmonary (Tobaldini et al, 2020(Tobaldini et al, , 2021, neurodegenerative (Carandina et al, 2022;Lazzeri et al, 2022) and autoimmune (Rodrigues et al, 2019(Rodrigues et al, , 2022 diseases. In recent years, the study of HRV has found increasingly wide applications, opening up fascinating research fields in various neurological and neuropsychiatric disturbances.…”