Valsalva maneuver unveils central baroreflex dysfunction with altered blood pressure control in persons with a history of mild traumatic brain injury

Hilz, Max J.; Liu, Mao; Koehn, Julia; Ammon, Fabian; Flanagan, Steven R.; Hösl, Katharina

doi:10.1186/s12883-016-0584-5

Cited by 45 publications

(107 citation statements)

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“…We speculate that the primary cause of the lack of an increase in total peripheral resistance is due to a reduction in sympathetic outflow in the concussed athletes, possibly owing to brainstem abnormalities (Levine et al 2008;Niogi et al 2008;Rutgers et al 2008;Huang et al 2009;Polak et al 2015). The return to resting systolic blood pressure after a Valsalva maneuver has been shown to be delayed in concussion patients (Hilz et al 2016;Dobson et al 2017). Contrary to our results, these findings suggest persistent sympathetic activation in concussion patients.…”

Section: Discussionmentioning

confidence: 92%

“…The return to resting systolic blood pressure after a Valsalva maneuver has been shown to be delayed in concussion patients (Hilz et al. ; Dobson et al. ).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, concussed patients demonstrate reduced resting cardiac baroreflex sensitivity (Hilz et al. , ) that might predispose them to larger reductions in blood pressure during orthostatic tests.…”

Section: Discussionmentioning

confidence: 99%

“…However, concussion patients have shown greater reductions in systolic blood pressure during orthostatic tests (Dobson et al 2017), which are in line with our results indicating attenuated sympathetic activation in concussed athletes. Furthermore, concussed patients demonstrate reduced resting cardiac baroreflex sensitivity (Hilz et al 2011(Hilz et al , 2016 that might predispose them to larger reductions in blood pressure during orthostatic tests. Contrary to our hypothesis, we did not find any significant correlations between reported symptoms and autonomic responses during face cooling in the concussed athletes.…”

Section: Discussionmentioning

confidence: 99%

“…Some investigators have found lower indices of resting heart rate variability (King et al 1997;Hilz et al 2011;Sung et al 2016), whereas others have not (Gall et al 2004;La Fountaine et al 2009;Kozlowski et al 2013;Abaji et al 2016). When concussion patients have been subjected to sympathoexcitatory maneuvers, such as orthostatic challenges, exercise, and the Valsalva maneuver, heart rate variability metrics and select cardiovascular responses are altered (Gall et al 2004;La Fountaine et al 2009;Hilz et al 2011Hilz et al , 2016Abaji et al 2016;Dobson et al 2017). These findings indicate that concussion patients exhibit altered autonomic activity in response to sympathetic stimuli compared to healthy controls.…”

Section: Introductionmentioning

confidence: 99%

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Face cooling exposes cardiac parasympathetic and sympathetic dysfunction in recently concussed college athletes

et al. 2018

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We tested the hypothesis that concussed college athletes (CA) have attenuated parasympathetic and sympathetic responses to face cooling (FC). Eleven symptomatic CA (age: 20 ± 2 years, 5 women) who were within 10 days of concussion diagnosis and 10 healthy controls (HC; age: 24 ± 4 years, 5 women) participated. During FC, a plastic bag filled with ice water (~0°C) was placed on the forehead, eyes, and cheeks for 3 min. Heart rate (ECG) and blood pressure (photoplethysmography) were averaged at baseline and every 60 sec during FC. High‐frequency (HF) power was obtained from spectral analysis of the R‐R interval. Data are presented as a change from baseline. Baseline heart rate (HC: 61 ± 12, CA: 57 ± 12 bpm; P = 0.69), mean arterial pressure (MAP) (HC: 94 ± 10, CA: 96 ± 13 mmHg; P = 0.74), and HF (HC: 2294 ± 2314, CA: 2459 ± 2058 msec2; P = 0.86) were not different between groups. Heart rate in HC decreased at 2 min (−7 ± 11 bpm; P = 0.02) but did not change in CA (P > 0.43). MAP increased at 1 min (HC: 12 ± 6, CA: 6 ± 6 mmHg), 2 min (HC: 21 ± 7, CA: 11 ± 7 mmHg), and 3 min (HC: 20 ± 6, CA: 13 ± 7 mmHg) in both groups (P < 0.01 for all) but the increase was greater at each interval in HC (P < 0.02). HF increased at 1 min (12354 ± 11489 msec2; P < 0.01) and 2 min (5832 ± 8002 msec2; P = 0.02) in HC but did not change in CA (P > 0.58). The increase in HF at 1 min was greater in HC versus CA (P < 0.01). These data indicate that symptomatic concussed patients have impaired cardiac parasympathetic and sympathetic activation.

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Section: Discussionmentioning

confidence: 92%

“…The return to resting systolic blood pressure after a Valsalva maneuver has been shown to be delayed in concussion patients (Hilz et al. ; Dobson et al. ).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Face cooling exposes cardiac parasympathetic and sympathetic dysfunction in recently concussed college athletes

et al. 2018

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Association Between Traumatic Brain Injury and Subsequent Cardiovascular Disease Among Post-9/11–Era Veterans

Stewart

Amuan

Wang³

et al. 2022

JAMA Neurol

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ImportanceTraumatic brain injury (TBI) was common among US service members deployed to Iraq and Afghanistan. Although there is some evidence to suggest that TBI increases the risk of cardiovascular disease (CVD), prior reports were predominantly limited to cerebrovascular outcomes. The potential association of TBI with CVD has not been comprehensively examined in post-9/11–era veterans.ObjectiveTo determine the association between TBI and subsequent CVD in post-9/11–era veterans.Design, Setting, and ParticipantsThis was a retrospective cohort study conducted from October 1, 1999, to September 30, 2016. Participants were followed up until December 31, 2018. Included in the study were administrative data from the US Department of Veterans Affairs and the Department of Defense from the Long-term Impact of Military-Relevant Brain Injury Consortium–Chronic Effects of Neurotrauma Consortium. Participants were excluded if dates did not overlap with the study period. Data analysis was conducted between November 22, 2021, and June 28, 2022.ExposuresHistory of TBI as measured by diagnosis in health care records.Main Outcomes and MeasuresComposite end point of CVD: coronary artery disease, stroke, peripheral artery disease, and cardiovascular death.ResultsOf the 2 530 875 veterans from the consortium, after exclusions, a total of 1 559 928 veterans were included in the analysis. A total of 301 169 veterans (19.3%; median [IQR] age, 27 [23-34] years; 265 217 male participants [88.1]) with a TBI history and 1 258 759 veterans (80.7%; median [IQR] age, 29 [24-39] years; 1 012 159 male participants [80.4%]) without a TBI history were included for analysis. Participants were predominately young (1 058 054 [67.8%] &lt;35 years at index date) and male (1 277 376 [81.9%]). Compared with participants without a history of TBI, diagnoses of mild TBI (hazard ratio [HR], 1.62; 95% CI, 1.58-1.66; P &lt; .001), moderate to severe TBI (HR, 2.63; 95% CI, 2.51-2.76; P &lt; .001), and penetrating TBI (HR, 4.60; 95% CI, 4.26-4.96; P &lt; .001) were associated with CVD in adjusted models. In analyses of secondary outcomes, all severities of TBI were associated with the individual components of the composite outcome except penetrating TBI and CVD death.Conclusions and RelevanceResults of this cohort study suggest that US veterans with a TBI history were more likely to develop CVD compared with veterans without a TBI history. Given the relatively young age of the cohort, these results suggest that there may be an increased burden of CVD as these veterans age and develop other CVD risk factors. Future studies are needed to determine if the increased risk associated with TBI is modifiable.

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Cardiovascular sequelae of sports‐related concussions

Krzyzaniak

Hassanabad

2021

PM&R

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We are becoming more aware of sports‐related concussions (SRCs). Current return‐to‐play (RTP) guidelines are often based on subjective clinical symptoms rather than objective physiologic measures. Although evidence is limited, the purpose of this article is to summarize the data pertaining to acute and chronic cardiovascular effects of SRCs, and to determine whether there are objective metrics that could improve currently used RTP protocols. Research shows that SRCs cause cardiovascular autonomic nervous system (CV‐ANS) dysfunction induced by decreased baroreceptor sensitivity (BRS). This disturbance persists past the point of clinical symptom resolution and can worsen through subsequent exertion, which may impact long‐term recovery. Further studies are needed to establish the most appropriate physiologic metrics for analyzing recovery post‐SRC and whether the addition of physiologic measures to RTP guidelines improves recovery from these injuries. This is an understudied area that carries important clinical implications. Larger and more robust trials are warranted to inform the development of guidelines that should focus on lessening the compounding effects of multiple concussions and improve the management of SRCs.

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Valsalva maneuver unveils central baroreflex dysfunction with altered blood pressure control in persons with a history of mild traumatic brain injury

Cited by 45 publications

References 91 publications

Face cooling exposes cardiac parasympathetic and sympathetic dysfunction in recently concussed college athletes

Face cooling exposes cardiac parasympathetic and sympathetic dysfunction in recently concussed college athletes

Association Between Traumatic Brain Injury and Subsequent Cardiovascular Disease Among Post-9/11–Era Veterans

Cardiovascular sequelae of sports‐related concussions

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