Cardiac and Vascular Sympathetic Baroreflex Control during Orthostatic Pre-Syncope

Furlan, Raffaello; Heusser, Karsten; Minonzio, Maura; Shiffer, Dana; Cairo, Beatrice; Tank, Jens; Jordan, Jens; Diedrich, André; Gauger, Peter; Zamuner, Antonio Roberto; Dipaola, Franca; Porta, Alberto; Barbic, Franca

doi:10.3390/jcm8091434

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Cardiac and Vascular Sympathetic Baroreflex Control during Orthostatic Pre-Syncope

^1,*,

¹,

¹,

²,

^2,4,

⁵,

²,

Antonio Roberto Zamuner

⁶

Franca Dipaola

¹,

Alberto Porta

^3,7

and

Franca Barbic

Department of Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas University, 20089 Rozzano, Italy

Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany

Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy

⁴

Chair of Aerospace Medicine, University of Cologne, 51147 Cologne, Germany

⁵

Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA

⁶

Departamento de Kinesiología, Universidad Católica del Maule, 3530000 Talca, Maule, Chile

⁷

Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico di San Donato, 20097 San Donato Milanese, Italy

Author to whom correspondence should be addressed.

J. Clin. Med. 2019, 8(9), 1434; https://doi.org/10.3390/jcm8091434

Received: 1 August 2019 / Revised: 4 September 2019 / Accepted: 5 September 2019 / Published: 10 September 2019

(This article belongs to the Special Issue Autonomic Nervous System: From Bench to Bedside)

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Abstract

We hypothesized that sympathetic baroreflex mediated uncoupling between neural sympathetic discharge pattern and arterial pressure (AP) fluctuations at 0.1 Hz during baroreceptor unloading might promote orthostatic pre-syncope. Ten volunteers (32 ± 6 years) underwent electrocardiogram, beat-to-beat AP, respiratory activity and muscle sympathetic nerve activity (MSNA) recordings while supine (REST) and during 80° head-up tilt (HUT) followed by −10 mmHg stepwise increase of lower body negative pressure until pre-syncope. Cardiac and sympathetic baroreflex sensitivity were quantified. Spectrum analysis of systolic and diastolic AP (SAP and DAP) and calibrated MSNA (cMSNA) variability assessed the low frequency fluctuations (LF, ~0.1 Hz) of SAP, DAP and cMSNA variability. The squared coherence function (K²) quantified the coupling between cMSNA and DAP in the LF band. Analyses were performed while supine, during asymptomatic HUT (T₁) and at pre-syncope onset (T₂). During T₂ we found that: (1) sympathetic baroreceptor modulation was virtually abolished compared to T₁; (2) a progressive decrease in AP was accompanied by a persistent but chaotic sympathetic firing; (3) coupling between cMSNA and AP series at 0.1 Hz was reduced compared to T₁. A negligible sympathetic baroreceptor modulation during pre-syncope might disrupt sympathetic discharge pattern impairing the capability of vessels to constrict and promote pre-syncope. View Full-Text

Keywords: syncope; vasovagal; baroreceptors; muscle sympathetic nerve activity; power spectrum analysis; heart rate variability; blood pressure variability; MSNA variability

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MDPI and ACS Style

Furlan, R.; Heusser, K.; Minonzio, M.; Shiffer, D.; Cairo, B.; Tank, J.; Jordan, J.; Diedrich, A.; Gauger, P.; Zamuner, A.R.; Dipaola, F.; Porta, A.; Barbic, F. Cardiac and Vascular Sympathetic Baroreflex Control during Orthostatic Pre-Syncope. J. Clin. Med. 2019, 8, 1434. https://doi.org/10.3390/jcm8091434

AMA Style

Furlan R, Heusser K, Minonzio M, Shiffer D, Cairo B, Tank J, Jordan J, Diedrich A, Gauger P, Zamuner AR, Dipaola F, Porta A, Barbic F. Cardiac and Vascular Sympathetic Baroreflex Control during Orthostatic Pre-Syncope. Journal of Clinical Medicine. 2019; 8(9):1434. https://doi.org/10.3390/jcm8091434

Chicago/Turabian Style

Furlan, Raffaello, Karsten Heusser, Maura Minonzio, Dana Shiffer, Beatrice Cairo, Jens Tank, Jens Jordan, André Diedrich, Peter Gauger, Antonio Roberto Zamuner, Franca Dipaola, Alberto Porta, and Franca Barbic. 2019. "Cardiac and Vascular Sympathetic Baroreflex Control during Orthostatic Pre-Syncope" Journal of Clinical Medicine 8, no. 9: 1434. https://doi.org/10.3390/jcm8091434

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