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Open AccessArticle

Sympatho–Vagal Dysfunction in Patients with End-Stage Lung Disease Awaiting Lung Transplantation

1
Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
2
Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
3
Department of Physiology and Pharmacology, Biomedical Institute, Fluminense Federal University, Niterói 24210-130, Brazil
4
Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
5
Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
6
Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
*
Author to whom correspondence should be addressed.
These authors contributed equally to the manuscript.
J. Clin. Med. 2020, 9(4), 1146; https://doi.org/10.3390/jcm9041146
Received: 7 March 2020 / Revised: 27 March 2020 / Accepted: 9 April 2020 / Published: 17 April 2020
(This article belongs to the Special Issue Autonomic Nervous System: From Bench to Bedside)
Although the literature demonstrates that cardiac autonomic control (CAC) might be impaired in patients with chronic pulmonary diseases, the interplay between CAC and disease severity in end-stage lung disease has not been studied yet. We investigated the effects of end-stage lung disease on CAC through the analysis of heart rate variability (HRV) among patients awaiting lung transplantation. Forty-nine patients on the waiting list for lung transplantation (LTx; 19 men, age 38 ± 15 years) and 49 healthy non-smoking controls (HC; 22 men, age 40 ± 16 years) were enrolled in a case–control study at Policlinico Hospital in Milan, Italy. LTx patients were divided into two groups, according to disease severity evaluated by the Lung Allocation Score (LAS). To assess CAC, electrocardiogram (ECG) and respiration were recorded at rest for 10 min in supine position and for 10 min during active standing. Spectral analysis identified low and high frequencies (LF, sympathetic, and HF, vagal). Symbolic analysis identified three patterns, i.e., 0V% (sympathetic) and 2UV% and 2LV% (vagal). Compared to HCs, LTx patients showed higher markers of sympathetic modulation and lower markers of vagal modulation. However, more severely affected LTx patients, compared to less severely affected ones, showed an autonomic profile characterized by loss of sympathetic modulation and predominant vagal modulation. This pattern can be due to a loss of sympathetic rhythmic oscillation and a subsequent prevalent respiratory modulation of heart rate in severely affected patients. View Full-Text
Keywords: heart rate variability; cardiac autonomic control; lung transplantation; spectral analysis; symbolic analysis; cardiac autonomic dysfunction; autonomic nervous system heart rate variability; cardiac autonomic control; lung transplantation; spectral analysis; symbolic analysis; cardiac autonomic dysfunction; autonomic nervous system
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MDPI and ACS Style

Tobaldini, E.; D. Rodrigues, G.; Mantoan, G.; Monti, A.; Coti Zelati, G.; Cirelli, C.; Tarsia, P.; Morlacchi, L.C.; Rossetti, V.; Righi, I.; Nosotti, M.; da S. Soares, P.P.; Montano, N.; Aliberti, S.; Blasi, F. Sympatho–Vagal Dysfunction in Patients with End-Stage Lung Disease Awaiting Lung Transplantation. J. Clin. Med. 2020, 9, 1146.

AMA Style

Tobaldini E, D. Rodrigues G, Mantoan G, Monti A, Coti Zelati G, Cirelli C, Tarsia P, Morlacchi LC, Rossetti V, Righi I, Nosotti M, da S. Soares PP, Montano N, Aliberti S, Blasi F. Sympatho–Vagal Dysfunction in Patients with End-Stage Lung Disease Awaiting Lung Transplantation. Journal of Clinical Medicine. 2020; 9(4):1146.

Chicago/Turabian Style

Tobaldini, Eleonora; D. Rodrigues, Gabriel; Mantoan, Giorgio; Monti, Alice; Coti Zelati, Giulia; Cirelli, Camilla; Tarsia, Paolo; Morlacchi, Letizia C.; Rossetti, Valeria; Righi, Ilaria; Nosotti, Mario; da S. Soares, Pedro P.; Montano, Nicola; Aliberti, Stefano; Blasi, Francesco. 2020. "Sympatho–Vagal Dysfunction in Patients with End-Stage Lung Disease Awaiting Lung Transplantation" J. Clin. Med. 9, no. 4: 1146.

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