Impairment of Autonomic Nervous System Activity in Patients With Pulmonary Arterial Hypertension: A Case Control Study |
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| Authors: | Stavros Dimopoulos Maria Anastasiou-Nana Fotios Katsaros Ourania Papazachou Georgios Tzanis Vasiliki Gerovasili Hercules Pozios Charis Roussos John Nanas Serafim Nanas |
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| Affiliation: | 1. Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland;2. Department of Pulmonary Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland;1. Department of Clinical and Molecular Medicine, University “La Sapienza”, Rome, Italy;2. Centro Cardiologico Monzino, IRCCS, University of Milan, Italy;3. Southampton Statistical Sciences Research Institute, School of Mathematics, University of Southampton, United Kingdom;4. Department of Public Institutions, Economy and Society, University “Roma Tre”, Rome, Italy;5. Cardiovascular Dept., “Ospedali Riuniti”, Trieste, Postgraduate School of Cardiovascular Sciences, University of Trieste, Italy;6. Department of Clinical Sciences and Community Health, University of Milan, Italy;1. Laboratorio de Fisiología Médica, Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana, Iztapalapa, D.F., México;2. División de Ciencias Básicas e Ingeniería, Universidad Autónoma Metropolitana, Iztapalapa, D.F., México;2. Department of Neurosciences, Case Western Reserve University, Cleveland, OH, USA;3. Department of Physiological Sciences, University of Florida, Gainesville, FL, USA;4. Department of Physiology, Michigan State University, East Lansing, MI, USA;5. Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL, USA |
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| Abstract: | BackgroundChronotropic response to exercise (CR) and heart rate recovery (HRR) immediately after exercise are indirect indices of sympathetic and parasympathetic activity, respectively. The aim of this study was to evaluate CR and HRR in patients with pulmonary arterial hypertension (PAH) in relation to disease severity.Methods and ResultsTen PAH patients (6 females/4 males, mean age: 48 ± 12 years) and 10 control subjects matched for age, gender, and body mass index (6 females/4 males, mean age: 46 ± 6 years) performed a ramp incremental symptom-limited cardiopulmonary exercise test on a cycle ergometer. Main measurements included heart rate at rest (HR), CR = [(peak HR-resting HR/220-age-resting HR) × 100, %], HRR1 = HR difference from peak exercise to 1 minute after, ventilatory efficiency during exercise (VE/VCO2 slope), peak oxygen uptake (VO2p), and the first-degree slope of VO2 for the first minute of the recovery period (VO2/t-slope). PAH patients had a significantly decreased CR (58 ± 31 vs 92 ± 13, %, P < .001) and HRR1 (10 ± 5 vs 29 ± 6, beats/min, P < .001) as well as VO2p (11.9 ± 3.5 vs 26.9 ± 6.6, mL·kg·min) and VO2/t-slope (0.2 ± 0.1 vs. 0.9 ± 0.2, mL·kg·min2) compared with controls. CR and HRR1 correlated well with VO2p (r = 0.7; P < .001 and r = 0.85; P < .001, respectively) and VO2/t-slope (r = 0.66; P < .001 and r = 0.85; P < .001, respectively) and had a significant inverse correlation with VE/VCO2 slope (r = –0.47; P < .01 and r = –0.77; P < .001, respectively).ConclusionsPAH patients present a significant impairment of CR and HRR1 in relation to disease severity, indicating profound autonomic nervous system abnormalities. |
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