Clinical Autonomic Research最新文献

Objective: This study compared clinical characteristics and response to head-up tilt test (HUTT) between micturition syncope (MS) and typical vasovagal syncope (VVS).

Methods: Consecutive patients who underwent nitroglycerin-potentiated HUTT were retrospectively dichotomized into two groups: those with a history of MS and those with a history of VVS. The patients with MS were further subdivided into patients with MS alone and with MS and at least one episode of VVS.

Results: A total of 2637 patients were enrolled: 204 had MS (MS alone in 103 and MS+VVS in 101), and 216 had typical VVS. Patients with MS were older (38.6 ± 13.1 vs. 36.3 ± 18.5, p = 0003) and more likely to be male (66.2% vs. 48.1%, p < 0.001). Multivariable analysis revealed that smoking habit (odds ratio [OR] 2.16, p < 0.0001), history of traumatic syncope (OR 2.24, p = 0.0001), and drinking alcohol before syncope (OR 2.63, p < 0.0001) were independently associated with MS. HUTT was positive in 141 (69.1%) patients with MS and in 144 (66.7%) patients with VVS (p = 0.592). Patients with MS showed more mixed (46.1% vs. 28.2%, p < 0.001) and vasodepressor forms (15.2% vs. 7.9%, p = 0.013) and fewer cardioinhibitory responses than others (7.4% vs. 30.6%, p < 0.001).

Conclusions: Compared with VVS, patients with MS have different clinical characteristics, and drinking alcohol was an important precipitating factor for MS. The positivity rate of HUTT is high and similar to that of VVS, although patients with MS show a higher prevalence of hypotensive responses.

Purpose: Postprandial hypotension (PPH) defined as a decrease in systolic blood pressure of more than 20 mmHg within 2 h post meal is prevalent in patients with autonomic failure and is associated with negative cardiovascular outcomes. Previous studies reported peripheral autonomic failure with less residual sympathetic tone in Parkinson disease (PD). Therefore, we hypothesized that PPH is more severe in PD than in multiple system atrophy (MSA) with central autonomic failure.

Methods: Thirteen patients with PD and 13 patients with MSA were enrolled. Autonomic function testing and neurohormonal measurements were performed to assess autonomic failure and residual sympathetic activity. Subjects were fed a standard breakfast. Systolic and diastolic blood pressure and heart rate were monitored every 5 min from 30 min before to 120 min post meal. Postprandial hemodynamic changes were summarized using area under the curve (AUC). Differences between the groups were assessed with two-sample independent t test and linear regression.

Results: Patients with PD (69% male, 72 ± 9 years) had a significantly lower post-meal diastolic blood pressure (P = 0.003) and heart rate AUC (P = 0.007) than patients with MSA (62% male, 62 ± 8 years). After adjusting for age and supine systolic blood pressure, PD as diagnosis still had significant estimate effect for diastolic blood pressure AUC (P = 0.019). No significant difference was found in the mean systolic blood pressure AUC, but at 30 min post meal, systolic blood pressure decrease was significantly lower in PD (P = 0.016).

Conclusion: The PD group with peripheral autonomic failure exhibits more severe PPH than the MSA group. This highlights the need for tailored management for PPH in PD.

Purpose: Central autonomic dysfunction is common in acute stroke and is associated with cardiovascular complications and increased mortality. The aim of this review is to present novel diagnostic and therapeutic approaches to the management of this disorder and the latest data on its impact on the clinical outcome after stroke.

Methods: We performed a narrative review of recent literature, with a particular focus on articles related to underlying pathophysiological mechanisms of cardiac autonomic dysregulation, the role of cardiac autonomic dysregulation in the activation of neuroinflammatory response and the development of cardiovascular, respiratory and metabolic complications in patients with ischemic and hemorrhagic stroke.

Results: The assessment of central autonomic dysfunction by non-invasive diagnostic techniques, including heart rate variability and baroreflex sensitivity, has gained wide practical application in recent years, and they may have a predictive role for evaluating disease prognosis. The emerging evidence derived from recent trials demonstrates that the presence of autonomic imbalance may lead to increased mortality and have an adverse effect on post-stroke rehabilitation.

Conclusion: The early detection and treatment of central autonomic system dysfunction may lead to improved survival of patients with stroke. Among the available therapeutic approaches, neuromodulatory techniques and pharmacological interventions are promising strategies which may be implemented as part of standard acute stroke care to improve patient recovery. Future studies are warranted to address the long-term effects of potential therapeutic agents on the modulation of cardiovascular autonomic function in stroke survivors.

Objectives: This study aimed to investigate the subjective and objective autonomic nervous system (ANS) abnormalities in children with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) compared with healthy children (HC).

Methods: In total, 69 children were enrolled: 23 in the IBD, 28 in the IBS, and 18 HC group. ANS symptoms were evaluated using the Composite Autonomic Symptom Score (COMPASS-31). The severity and distribution of ANS function were quantitated using adrenergic, cardiovagal, and sudomotor indices of the Composite Autonomic Severity Scale (CASS). Health-related quality of life (HRQoL) was assessed with the Pediatric Quality of Life Inventory (PedsQL).

Results: Children with IBS scored highest on the COMPASS-31, followed by patients with IBD and HC (median 11.5, 6.3, and 1.7, respectively; p = 0.001). There was no significant difference between groups in CASS (p = 0.09); however, children with IBD had a higher score on the sudomotor index (p = 0.012). There was a significant difference in symptomatic autonomic dysfunction (defined as COMPASS-31 > 7.913 and CASS > 0) between children with IBS (61.5%) compared with children with IBD (42.1%) and HC (7.1%), p = 0.004. In multivariable logistic regression, the number of squats decreased the probability of special health care needs by 17.2%, and the presence of symptomatic autonomic dysfunction increased the probability by 515.4%.

Conclusions: The ANS is frequently affected in children with IBD and IBS; children with IBS show greater autonomic symptom burden, while children with IBD have greater sudomotor dysfunction. HRQoL is significantly influenced by observed ANS changes in both groups.