Five-Year Follow-up of Patients After Thromboendarterectomy of the Internal Carotid Artery

Hirschl, Mirko; Kundi, Michael; Blazek, Gerhard

doi:10.1161/01.str.27.7.1167

Cited by 40 publications

(40 citation statements)

References 27 publications

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“…For instance, in secondary prevention, endarterectomy of the internal carotid artery showed the increase of BRS and its improving was correlated to cardiovascular events at a 5-year interval. 30 This longitudinal study confirms the age-related decrease in BRS already reported in cross sectional studies. In men aged 18 to 50 years, the decrease in BRS was evaluated at 3.6% a year.…”

Section: Perspectivessupporting

confidence: 90%

Aging Process on Spectrally Determined Spontaneous Baroreflex Sensitivity

et al. 2007

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Abstract-The interindividual age-related decrease in baroreflex sensitivity (BRS) was reported in many cross-sectional studies. However, the long-term intraindividual decrease in BRS has never been confirmed by longitudinal studies. Data obtained from a 5-year prospective study designed to assess the 5-year stress effects on blood pressure (BP) provided the opportunity to assess longitudinal aging process on spectrally determined BRS (S-BRS) using the cross spectral analysis. This analysis was carried out in 205 men aged between 18 and 50 years who had 2 valid beat to beat BP recordings (Finapress) at a mean 5-year interval. At inclusion and at end of follow-up, S-BRS was significantly correlated with age (rϭϪ0. 50, PϽ0.001, rϭϪ0.33, PϽ0.001 respectively). Interestingly, the slopes and the intercepts were not significantly different at a 5-year interval. This result is in favor of the good reproducibility of S-BRS. The attenuation with age of S-BRS was calculated at 3.6% a year. This decrease was slightly higher than the one obtained with the baseline data (2.3% per year). This longitudinal study provided, for the first time, an estimate of the slope of the age-related physiological S-BRS decrease in a mid-aged healthy male population. Our findings reinforce the interest of evaluating spontaneous BRS reported to predict hypertension and cardiovascular events in various populations. Key Words: mental stress Ⅲ baroreflex Ⅲ hypertension Ⅲ blood pressure Ⅲ reproducibility B aroreflex sensitivity (BRS) is a relevant index of the autonomic control of blood pressure (BP). Historically, BRS was determined using drug-induced BP and heart rate (HR) opposite variations. More recently, noninvasive techniques of determining spontaneous BRS have been implemented, 1-3 the spectral method being one of the most popular. The spectral determination of BRS (S-BRS) is a reliable measure of BRS because it has often been reported to be correlated with the pharmacologically determined BRS. 4 -7 S-BRS is easy to determine, and repeated measures are easy to make. Aging process on S-BRS has already been reported in several cross sectional studies. 8 -12 Such studies only report interindividual S-BRS variation with age. Thus, S-BRS has consistently been reported to decrease with age. Physiological aging in men was associated with a marked reduction in baroreflex buffering. A differential aging process on baroreflex buffering BP and cardiovagal baroreflex was reported. 10 The decrease in baroreflex buffering with aging was related to an increase in basal sympathetic nerve activity and to a reduction in systemic Alpha1-adrenergic vascular responsiveness whereas the decrease in cardiovagal baroreflex was related to a decrease in parasympathetic pathways. 10,13 However, to our knowledge, the intraindividual BRS alteration with age has never been reported. For that purpose, we analyzed the S-BRS 5-year aging process in a cohort of 205 healthy young men. This unique data set was extracted from a 5-year follow-up study designed to assess stress ...

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Section: Perspectivessupporting

confidence: 90%

Aging Process on Spectrally Determined Spontaneous Baroreflex Sensitivity

et al. 2007

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“…When considering predictors of cardiac BRS, age seems to be the strongest predictor for the younger group and SBP for the older group, but this hypothesis needs further testing. We should consider the influence of these patient demographic factors on BRS values, if we are to use them as prognostic indicators [30,31] and derive a set of ageadjusted values for clinical reference.…”

Section: Brs and Gendermentioning

confidence: 99%

Older subjects show no age-related decrease in cardiac baroreceptor sensitivity

Dawson

Robinson²,

Youde³

et al. 1999

Age and Ageing

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Objective: to examine the relationship between age, blood pressure and cardiac baroreceptor sensitivity derived from spectral analysis, the Valsalva manoeuvre and impulse response function. Methods: we studied 70 healthy normotensive volunteers who were free from disease and not taking medication with cardiovascular or autonomic effects. We measured beat-to-beat arterial blood pressure and used standard surface electrocardiography to record pulse interval under standardized conditions with subjects resting supine as well as during three Valsalva manoeuvres. We performed single, multiple and stepwise regression of patient characteristics against cardiac baroreceptor sensitivity results. Results: there is a non-linear decline in cardiac baroreceptor sensitivity with advancing age, increasing systolic blood pressure and heart rate values (except for the Valsalva-derived result), but little further decline after the fourth decade. Only age significantly influenced values derived using the Valsalva manoeuvre and impulse response analysis. Using spectral analysis, age, systolic and diastolic blood pressure and heart rate influenced cardiac baroreceptor sensitivity, age contributing to 50% of the variability. Age also influenced the relationship between pulse interval and blood pressure, possibly indicating more non-baroreceptor-mediated changes with advancing age. Conclusions: although age is the dominant factor influencing cardiac baroreceptor sensitivity in this normotensive population, there is little change in mean values after 40 years of age. The differences in the relationship between pulse interval and blood pressure with advancing age have implications for the calculation of cardiac baroreceptor sensitivity using spectral analysis.

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“…9 BRS modifications after carotid endarterectomy have largely been addressed in previous work. 10,11 In contrast, very few studies have investigated the impact of carotid atherosclerosis (CA) on BRS reduction in patients who have not undergone carotid surgery. These studies did not consider the role of CA characteristics such as bilaterality and different degrees of CA severity.…”

mentioning

confidence: 99%

Baroreflex Sensitivity Is Impaired in Bilateral Carotid Atherosclerosis

Nasr

Traon

Larrue

2005

Stroke

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Background and Purpose-The arterial baroreflex is an important determinant of the short-term regulation of blood pressure and cardiovascular variability. The purpose of our study was to determine whether baroreflex sensitivity (BRS) and heart rate (HR) variability are altered in patients with carotid atherosclerosis (CA) and to assess the impact of characteristics of CA on BRS. Methods-BRS and HR variability were prospectively evaluated in 75 consecutive patients undergoing carotid duplex examination in our neurosonology unit. Resting BRS was measured with the sequence method. HR variability was evaluated using spectral analysis. Results-BRS was significantly reduced in patients with bilateral CA compared with patients without CA (Pϭ0.015) and patients with unilateral CA (Pϭ0.045). BRS was unaltered in patients with unilateral CA compared with patients with no CA. BRS was already reduced in mild (stenosis Ͻ50%), bilateral CA and was not further impaired in more severe CA. The association of BRS impairment with bilateral CA remained significant after adjustment for age, hypertension, and a history of stroke or transient ischemic attack. The study of HR variability demonstrated a reduction in the power of high-frequency band in patients with bilateral CA compared with patients with unilateral CA or without CA (Pϭ0.015). Conclusion-Bilateral

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Five-Year Follow-up of Patients After Thromboendarterectomy of the Internal Carotid Artery

Abstract: Because an improvement of receptor sensitivity after carotid surgery is related to a long-lasting reduction of blood pressure levels and variability, baroreceptor function may be considered an indirect indicator for the later postoperative course.

Cited by 40 publications

References 27 publications

Aging Process on Spectrally Determined Spontaneous Baroreflex Sensitivity

Aging Process on Spectrally Determined Spontaneous Baroreflex Sensitivity

Older subjects show no age-related decrease in cardiac baroreceptor sensitivity

Baroreflex Sensitivity Is Impaired in Bilateral Carotid Atherosclerosis

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