Evaluation of Baroreflex Sensitivity by the Sequence Method Using Blood Pressure Oscillations and R–R Interval Changes during Deep Respiration

Oka, Hiroyuki; Mochio, Soichiro; Yoshioka, Masayuki; Morita, Masayo; Inoue, Kiyoharu

doi:10.1159/000073865

Cited by 32 publications

(23 citation statements)

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“…Studies of reflexive cardiovagal function have sometimes found 9,31 and sometimes not found 8,12 abnormalities overall in PD. PDϩOH patients have attenuated reflexive cardiovagal gain assessed by heart rate and blood pressure changes during phase II of the Valsalva maneuver and have attenuated orthostatic increments in plasma NE, 2 consistent with decreased reflexive cardiovagal and sympathetic neurocirculatory function.…”

Section: Discussionmentioning

confidence: 99%

“…Combined levodopa/carbidopa treatment attenuates but does not prevent catecholamine synthesis from levodopa outside the brain. 6,7 Reflexive cardiovagal gain has been reported to be variably decreased in PD 8,9 and markedly decreased in PDϩOH. 10 Levodopa treatment of PD can affect reflexive cardiovagal function, 11 and decreased reflexive cardiovagal gain is more prominent in patients with long-standing PD, 12 who would be expected to be on levodopa.…”

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confidence: 99%

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Neurocirculatory Abnormalities in Parkinson Disease With Orthostatic Hypotension

et al. 2005

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Abstract-Patients with Parkinson disease often have orthostatic hypotension. Neurocirculatory abnormalities underlying orthostatic hypotension might reflect levodopa treatment. Sixty-six Parkinson disease patients (36 with orthostatic hypotension, 15 off and 21 on levodopa; 30 without orthostatic hypotension) had tests of reflexive cardiovagal gain (decrease in interbeat interval per unit decrease in systolic pressure during the Valsalva maneuver; orthostatic increase in heart rate per unit decrease in pressure); reflexive sympathoneural function (decrease in pressure during the Valsalva maneuver; orthostatic increment in plasma norepinephrine); and cardiac and extracardiac noradrenergic innervation (septal myocardial 6-͓ 18 F͔fluorodopamine-derived radioactivity; supine plasma norepinephrine). Severity of orthostatic hypotension did not differ between the levodopa-untreated and levodopa-treated groups with Parkinson disease and orthostatic hypotension (Ϫ52Ϯ6 ͓SEM͔ versus Ϫ49Ϯ5 mm Hg systolic). The 2 groups had similarly low reflexive cardiovagal gain (0.84Ϯ0.23 versus 1.33Ϯ0.35 ms/mm Hg during Valsalva; 0.43Ϯ0.09 versus 0.27Ϯ0.06 bpm/mm Hg during orthostasis); and had similarly attenuated reflexive sympathoneural responses (97Ϯ29 versus 71Ϯ23 pg/mL during orthostasis; Ϫ82Ϯ10 versus Ϫ73Ϯ8 mm Hg during Valsalva). In patients off levodopa, plasma norepinephrine was lower in those with (193Ϯ19 pg/mL) than without (348Ϯ46 pg/mL) orthostatic hypotension. Low values for reflexive cardiovagal gain, sympathoneural responses, and noradrenergic innervation were strongly related to orthostatic hypotension. Parkinson disease with orthostatic hypotension features reflexive cardiovagal and sympathoneural failure and cardiac and partial extracardiac sympathetic denervation, independent of levodopa treatment. Key Words: hypotension Ⅲ sympathetic nervous system Ⅲ norepinephrine Ⅲ baroreflex P rimary chronic autonomic failure syndromes have been classified clinically in 3 forms: pure autonomic failure (PAF), multiple system atrophy (MSA), and Parkinson disease (PD) with autonomic failure. 1 All 3 forms feature neurogenic orthostatic hypotension (OH), supine hypertension, 2,3 and attenuation of the orthostatic increase in the plasma level of norepinephrine (NE), the sympathetic neurotransmitter. 4,5 Levodopa is a precursor of dopamine and therefore of NE. In the treatment of PD, levodopa is usually combined with an inhibitor of L-aromatic-acid-decarboxylase, such as carbidopa, which does not penetrate the blood-brain barrier. Combined levodopa/carbidopa treatment therefore augments delivery of levodopa to the brain and mitigates nausea and vomiting thought to result from occupation of dopamine receptors outside the blood-brain barrier. Combined levodopa/carbidopa treatment attenuates but does not prevent catecholamine synthesis from levodopa outside the brain. 6,7 Reflexive cardiovagal gain has been reported to be variably decreased in PD 8,9 and markedly decreased in PDϩOH. 10 Levodopa treatment of PD can affect reflexive cardiov...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Neurocirculatory Abnormalities in Parkinson Disease With Orthostatic Hypotension

et al. 2005

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“…Clinically significant autonomic dysfunction, including constipation, orthostatic hypotension, postprandial hypotension, impaired baroreceptor reflex, and sweating disturbance, can also occur in PD [39,40,46]. Cardiac autonomic dysfunction may develop in early PD, because 123 I-meta-iodobenzylguanidine ( 123 I-MIBG) uptake by the heart is reduced even in patients with very early PD according to the Hoehn-Yahr staging system, without clinically significant signs or symptoms of autonomic dysfunction [42,44].…”

Section: Introductionmentioning

confidence: 99%

Olfactory dysfunction and cardiovascular dysautonomia in Parkinson’s disease

Oka¹,

Toyoda²,

Yogo³

et al. 2010

J Neurol

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Several studies have reported that olfactory dysfunction is an early neuropathological manifestation of Parkinson's disease (PD). Reduced cardiac meta-iodobenzylguanidine ((123)I-MIBG) uptake may be one of the earliest signs of PD. We studied the relation of olfactory dysfunction to cardiovascular dysautonomia in patients with PD. The study group comprised 66 patients with PD (70.5 years) and 26 controls (70.3 years) for olfactory assessment, 21 controls (72.1 years) for cardiac (123)I-MIBG scintigraphy and heart rate variability (HRV), assessed using the coefficient of variation for RR intervals (HRV), and 23 controls (69.2 years) for orthostatic blood pressure response. Olfactory function was assessed by the odor stick identification test Japan (OSIT-J), and cardiovascular autonomic function was evaluated by (123)I-MIBG scintigraphy of the heart, the fall in orthostatic blood pressure, and HRV. Patients with PD had a significantly lower OSIT-J score than did the controls (4.1 +/- 3.0 vs. 9.9 +/- 1.7, p = 0.001). The OSIT-J score was unrelated to variables other than gender, including age, disease duration, motor score on the unified Parkinson's disease rating scale, score on the mini-mental state examination, motor phenotype, visual hallucinations, and dopaminergic medication on multiple regression and logistic regression analyses. The OSIT-J score was related to the heart/mediastinum ratio of cardiac (123)I-MIBG uptake, the fall in orthostatic blood pressure, and HRV, after adjustment for other clinical variables. Olfactory dysfunction in PD was, thus, significantly related to both cardiac sympathetic and parasympathetic dysfunction, as well as vascular sympathetic dysfunction. As non-motor symptoms of PD, olfactory dysfunction and autonomic network failure appear to be closely related in PD.

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“…Generally, linear regression is applied to contiguous sequences and a BRS estimate is obtained by averaging the slopes of all valid sequences. Insufficient correlation between the input and output points in a sequence, low number of points in a sequence, or insufficient number of sequences can all be a major problem, especially in patients with cardiac disease [6].…”

Section: A) Time-domain Methodsmentioning

confidence: 99%

“…A number of studies use an external stimulus to provide some excitation of the baroreflex loop, such as injection of vasoactive drugs, neck suction [7] or Valsalva manoeuvre [6]. A simple linear regression (using all of the data, without selection into sequences) is then used to estimate BRS.…”

Section: A) Time-domain Methodsmentioning

confidence: 99%

A system identification approach to baroreflex sensitivity estimation

McLoone

Ringwood

2012

IET Irish Signals and Systems Conference (ISSC 2012)

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-The body contains a bewildering array of regulatory systems which maintain homeostasis. There is considerable difficulty in isolating a single control loop for analysis, due to the interactions with other systems/loops. One important such regulatory loop is the baroreflex, and baroreflex sensitivity is a characteristic open-loop parameter which can help us to assess the health of the baroreflex. A diverse range of methods have been proposed to determine baroreflex sensitivity from experimental data. Unfortunately, there appears to be little consistency of result among the different methods and some explanation can be found in the nature of the problem: In most cases, an attempt is being made to determine open-loop measures from a system operating in closed-loop, subject to poor excitation. In this paper we propose a strict procedure, based on a rigourous mathematical framework, from which reliable estimates of baroreflex sensitivity can be obtained. A comparison with other methods for baroreflex sensitivity estimation, using the EuroBaVar data set, is performed.

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Evaluation of Baroreflex Sensitivity by the Sequence Method Using Blood Pressure Oscillations and R–R Interval Changes during Deep Respiration

Cited by 32 publications

References 10 publications

Neurocirculatory Abnormalities in Parkinson Disease With Orthostatic Hypotension

Neurocirculatory Abnormalities in Parkinson Disease With Orthostatic Hypotension

Olfactory dysfunction and cardiovascular dysautonomia in Parkinson’s disease

A system identification approach to baroreflex sensitivity estimation

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