Orthostatic intolerance (OI) is defined as the development of characteristic symptoms while standing, which significantly improve by recumbency. The most common forms are vasovagal syncope (VVS), orthostatic hypotension, and postural orthostatic tachycardia syndrome (POTS). Lately, there has been a growing body of evidence that autoimmunity may play a role in the pathophysiology of orthostatic intolerance syndromes. The aim was to compare the presence and levels of autoimmune autoantibodies in patients with POTS, VVS syncope, and the control group. Altogether, 61 patients with symptoms of orthostatic intolerance were evaluated in this study - 19 POTS patients and 42 VVS patients. The control group contained 22 patients with no signs of orthostatic intolerance. We evaluated levels of autoantibodies against three subtypes of G-protein coupled adrenergic receptor (alpha-1 and beta-1,2 adrenergic receptors), type 4 of muscarinic acetylcholine receptor, and angiotensin II type 1 receptor. We compared the levels between the three patient groups. Significantly higher levels of angiotensin II type 1 receptor (AT1R) autoantibodies were found in the POTS group compared with controls (0.67± 0.35 ng/ml vs. 0.38±0.32 ng/ml, p=0.008). There was no significant difference in AT1R antibodies between the VVS and control groups (0.46±0.34 ng/ml vs 0.38±0.32 ng/ml, p= 0.38). Autoantibody concentration against ADRA1, ADRB1, ADRB2, and M4R were not significantly different between the groups. Autoimmune mechanisms may lead to abnormal regulation of the renin-angiotensin-aldosterone system and may contribute to the pathophysiology of POTS.
- MeSH
- autoimunita * MeSH
- autoprotilátky * krev MeSH
- biologické markery krev MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- ortostatická intolerance * krev imunologie diagnóza MeSH
- receptor angiotensinu typ 1 imunologie MeSH
- syndrom posturální ortostatické tachykardie * imunologie krev diagnóza MeSH
- vazovagální synkopa * imunologie krev diagnóza MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- autoprotilátky * MeSH
- biologické markery MeSH
- receptor angiotensinu typ 1 MeSH
Cardioneuroablation has emerged as a potential alternative to cardiac pacing in selected cases with vasovagal reflex syncope, extrinsic vagally induced sinus bradycardia-arrest or atrioventricular block. The technique was first introduced decades ago, and its use has risen over the past decade. However, as with any intervention, proper patient selection and technique are a prerequisite for a safe and effective use of cardioneuroablation therapy. This document aims to review and interpret available scientific evidence and provide a summary position on the topic.
- Klíčová slova
- Atrioventricular block, Autonomic nervous system, Reflex syncope, Sinus bradycardia, Vasovagal syncope,
- MeSH
- ablace MeSH
- bradykardie * terapie patofyziologie chirurgie diagnóza MeSH
- katetrizační ablace metody MeSH
- konsensus MeSH
- lidé MeSH
- srdeční frekvence MeSH
- vazovagální synkopa * chirurgie diagnóza patofyziologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- směrnice pro lékařskou praxi MeSH
- Klíčová slova
- autonomic nervous system, cardioneuroablation, catheter ablation, extracardiac vagal stimulation, functional bradycardia, ganglionic plexi, syncope,
- MeSH
- bradykardie chirurgie MeSH
- katetrizační ablace * škodlivé účinky MeSH
- lidé MeSH
- vazovagální synkopa * chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- úvodníky MeSH
Orthostatic intolerance (OI) is defined as a group of diseases which symptoms are typically manifested in a standing position. These symptoms result from cerebral hypoperfusion and disappear in the supine position. We include postural orthostatic intolerance syndrome (POTS), orthostatic hypotension (OH) and vasovagal orthostatic syncope in this group of diseases. Each of them have similar clinical presentation (blurred vision, weakness, dizziness, nausea, headaches, fatigue). However, they vary from each other in biochemical, autonomic and hemodynamic characteristics. The aim of the work is to provide an overview of humoral and non-human markers that are involved in the etiopathogenesis of orthostatic intolerance.
- Klíčová slova
- POTS, biomarker, biomarkers, orthostatic intolerance, vasovagal syncope,
- MeSH
- biologické markery MeSH
- lidé MeSH
- ortostatická intolerance * diagnóza MeSH
- syndrom posturální ortostatické tachykardie * diagnóza MeSH
- synkopa diagnóza MeSH
- vazovagální synkopa * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- biologické markery MeSH
[Figure: see text]
- Klíčová slova
- Catheter ablation, Methods, Neurally mediated syncope, Reflex syncope, Syncope, Vasovagal syncope,
- MeSH
- bradykardie MeSH
- lidé MeSH
- reflex MeSH
- vazovagální synkopa * diagnóza chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
The endothelin system may play a role in the pathogenesis of vasovagal syncope (VVS) because it is implicated in blood pressure regulation. We hypothesized that endothelin-related genetic polymorphisms might modulate susceptibility to VVS. This study aimed to evaluate the possible influence of endothelin-1 (EDN1) and endothelin receptor A (EDNRA) gene variants on the occurrence of tilt-induced VVS and autonomic nervous system activity during the head-up tilt test (HUT). Results were expressed as mean +/- SEM. In 254 patients with recurrent syncope (age 45.33+/-1.22 years, 94 males, 160 females), heart rate variability (HRV) was measured during HUT. EDN1 rs5370 G>T and EDNRA rs5333 T>C gene polymorphisms were assessed using high-resolution melting analysis. There was no statistically significant association between polymorphisms EDN1 rs5370 and EDNRA rs5333 and positivity of HUT or hemodynamic types of VVS. Patients with GT or TT genotypes at the rs5370 locus of the EDN1 had significantly higher values of high-frequency (HF) and the standard deviation of the average NN intervals at the time of the syncope, and they tended to have lower low-frequency (LF) and LF/HF ratio when compared to homozygotes (GG). No statistically significant differences were found in HRV parameters concerning the EDNRA rs5333 genotypes. Our findings suggest the potential role of EDN1 rs5370 variants in regulating autonomic nervous activity and pathogenesis of VVS.
- MeSH
- dospělí MeSH
- endotelin-1 * genetika MeSH
- lidé středního věku MeSH
- lidé MeSH
- polymorfismus genetický genetika MeSH
- receptor endotelinu A genetika MeSH
- srdeční frekvence genetika MeSH
- test na nakloněné rovině MeSH
- vazovagální synkopa * diagnóza genetika MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- EDNRA protein, human MeSH Prohlížeč
- endotelin-1 * MeSH
- receptor endotelinu A MeSH
Numerous countermeasures have been proposed to minimize microgravity-induced physical deconditioning, but their benefits are limited. The present study aimed to investigate whether personalized aerobic exercise based on artificial gravity (AG) mitigates multisystem physical deconditioning. Fourteen men were assigned to the control group (n=6) and the countermeasure group (CM, n=8). Subjects in the CM group were exposed to AG (2 Gz at foot level) for 30 min twice daily, during which time cycling exercise of 80-95 % anaerobic threshold (AT) intensity was undertaken. Orthostatic tolerance (OT), exercise tests, and blood assays were determined before and after 4 days head-down bed rest (HDBR). Cardiac systolic function was measured every day. After HDBR, OT decreased to 50.9 % and 77.5 % of pre-HDBR values in control and CM groups, respectively. Exercise endurance, maximal oxygen consumption, and AT decreased to 96.5 %, 91.5 % and 91.8 % of pre-HDBR values, respectively, in the control group. Nevertheless, there were slight changes in the CM group. HDBR increased heart rate, sympathetic activity, and the pre-ejection period, but decreased plasma volume, parasympathetic activity and left-ventricular ejection time in the control group, whereas these effects were eliminated in the CM group. Aldosterone had no change in the control group but increased significantly in the CM group. Our study shows that 80-95 % AT aerobic exercise based on 2 Gz of AG preserves OT and exercise endurance, and affects body fluid regulation during short-term HDBR. The underlying mechanisms might involve maintained cardiac systolic function, preserved plasma volume, and improved sympathetic responses to orthostatic stress.
- MeSH
- časové faktory MeSH
- cvičení fyziologie MeSH
- dospělí MeSH
- gravitace změněná * MeSH
- klid na lůžku metody MeSH
- krevní tlak fyziologie MeSH
- lidé MeSH
- mladý dospělý MeSH
- ortostatická intolerance diagnóza patofyziologie MeSH
- simulace stavu beztíže metody MeSH
- spotřeba kyslíku fyziologie MeSH
- srdeční frekvence fyziologie MeSH
- Trendelenburgova poloha fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
AIMS: In patients with severe neurally mediated syncope (NMS), radiofrequency catheter ablation (RFA) of ganglionic plexi (GP) has been proposed as a new therapeutic approach. Cardio-inhibitory response during NMS is usually related to the sinoatrial (SA) and less frequently to atrioventricular (AV) node. Differential effect of GP ablation on SA and AV node is poorly understood. METHODS AND RESULTS: We report a case of a 35-year-old female with frequent symptomatic episodes of advanced AV block treated by anatomically guided RFA at empirical sites of GPs. After RFA at the septal portion of the right atrium-superior vena cava junction, heart rate accelerated from 62 to 91 beats/min and PR interval prolonged from 213 to 344 ms. Sustained first-degree AV block allowed to observe directly the effects of subsequent RFA on the AV nodal properties. Subsequent RFA at right- and left-sided aspects of the inter-atrial septum had no further effect on heart rate and PR interval. Ablation at the inferior left GP was critical for restoration of normal AV conduction (final PR interval of 187 ms). No bradycardia episodes were observed by implantable loop recorder during the follow-up of 10 months and the patient was symptomatically improved. CONCLUSION: This is the first clinical case showing the differential effect of GP ablation on SA and AV nodal function, and critical importance of targeting the GP at the postero-inferior left atrium. The successful procedure corroborates clinical utility of ablation treatment instead of pacemaker implantation in selected patients with cardio-inhibitory NMS.
- Klíčová slova
- Atrioventricular block, Autonomic regulations, Catheter ablation, Ganglionic plexi, Neurally mediated syncope,
- MeSH
- akční potenciály MeSH
- atrioventrikulární blokáda diagnóza patofyziologie chirurgie MeSH
- autonomní denervace metody MeSH
- časové faktory MeSH
- dospělí MeSH
- elektrofyziologické techniky kardiologické MeSH
- elektrokardiografie MeSH
- ganglia autonomní patofyziologie chirurgie MeSH
- katetrizační ablace * MeSH
- lidé MeSH
- nodus atrioventricularis patofyziologie MeSH
- nodus sinuatrialis patofyziologie MeSH
- recidiva MeSH
- srdeční frekvence MeSH
- stupeň závažnosti nemoci MeSH
- vazovagální synkopa diagnóza patofyziologie chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
INTRODUCTION: Cardiovascular autonomic neuropathy in diabetics is a common but often underestimated and underdiagnosed complication of diabetes mellitus. One of the most clinical apparent forms of cardiovascular autonomic neuropathy is orthostatic hypotension. OBJECTIVES: To retrospectively assess the association of the orthostatic hypotension (OH) with macrovascular and microvascular complications of diabetes mellitus and to determine its effect on mortality. DESIGN AND METHODS: We retrospectively analyzed 187 patients with diabetes mellitus (60 patients with diabetes type 1 and 127 patients with diabetes type 2). Patients were divided into groups according to presence or absence of OH and type of diabetes. Association of OH with macrovascular and microvascular complications was evaluated and the effect of OH on 10-year all-cause mortality was also assessed. RESULTS: OH was present in 31.7% of patients with diabetes type 1 (DM1) and in 32.3% of patients with diabetes type 2 (DM2). OH was positively associated with the prevalence of myocardial infarction in DM1 (OR=10.67) and with prevalence of stroke in DM2 (OR=3.33). There was also a strong association of OH and the prevalence of peripheral artery disease in both DM1 (OR=14.18) and DM2 (OR=3.26). Patients with both types of diabetes and OH had significantly higher prevalence of nephropathy (DM1 OR=8.68, DM2 OR=3.24), retinopathy (DM1 OR=8.09, DM2 OR=4.08) and peripheral neuropathy (DM1 OR=17.14, DM2 OR=7.51) Overall 10year mortality rate was higher in diabetic patients with OH. CONCLUSIONS: Presence of OH in diabetics is associated with higher prevalence of macrovascular and microvascular complications of diabetes mellitus and also with higher 10-year mortality.
- Klíčová slova
- Diabetes mellitus, Diabetic cardiovascular autonomic neuropathy, Microvascular and macrovascular complications, Mortality, Orthostatic hypotension,
- MeSH
- ambulantní kliniky nemocniční MeSH
- diabetes mellitus 1. typu komplikace MeSH
- diabetes mellitus 2. typu komplikace MeSH
- diabetická kardiomyopatie komplikace epidemiologie mortalita patofyziologie MeSH
- diabetické angiopatie komplikace epidemiologie mortalita patofyziologie MeSH
- diabetické nefropatie komplikace epidemiologie mortalita patofyziologie MeSH
- diabetické neuropatie komplikace epidemiologie mortalita patofyziologie MeSH
- dospělí MeSH
- kardiovaskulární nemoci komplikace epidemiologie mortalita patofyziologie MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mortalita MeSH
- následné studie MeSH
- nemocnice univerzitní MeSH
- ortostatická hypotenze komplikace epidemiologie mortalita patofyziologie MeSH
- prevalence MeSH
- renální insuficience komplikace epidemiologie mortalita patofyziologie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Slovenská republika epidemiologie MeSH
