Autonomic Nervous System Diseases

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Review Article

I – Evaluation of Cardiovascular Autonomic Function in Healthy Individuals

Benedito Carlos Maciel et al. Lourenço Gallo-Jr André Schmidt José Antonio Marin-Neto

Abstract

This first part of the review presents nearly 60 years of experience from our laboratory in standardizing cardiovascular autonomic tests in healthy individuals. The wide range of tests includes pharmacological blockade of both the sympathetic and parasympathetic divisions, baroreflex sensitivity assessment through transient hypertension and hypotension, the Valsalva maneuver, head-up tilt testing, isometric and dynamic exercise, facial immersion in cold water, respiratory sinus arrhythmia, heart rate variability analysis in the frequency domain, and imaging with ¹²³I-metaiodobenzylguanidine. Autonomic function was evaluated based on test responses under baseline conditions in healthy individuals. The analysis also covers physiological adaptations to endurance training and aging, providing a reference framework for identifying autonomic dysfunction involving both parasympathetic and adrenergic components in patients with various pathophysiological conditions, as discussed in the second part of this review.

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Review Article

II – Evaluation of Autonomic Control of Heart Rate in Various Clinical Conditions

Benedito Carlos Maciel et al. Lourenço Gallo-Jr André Schmidt José Antonio Marin-Neto

Abstract

Through the comparison of responses of normal volunteers, assessment of autonomic function under abnormal clinical conditions focused on the detection of dysautonomia involving both the parasympathetic and adrenergic limbs in patients with Chagas heart disease, post-cardiac surgery, chronic heart failure, mitral valve prolapse, and hyperthyroidism. In particular, the autonomic impairment observed in Chagas disease patients involved predominantly the parasympathetic control of heart rate at the sinus node level, and the adrenergic innervation at the myocardial ventricular level. The autonomic derangements observed in Chagas cardiomyopathy patients have only recently been explored in terms of their prognostic relevance, and their potential clinical implications for therapeutic purposes remain to be investigated.

Over the last nearly seven decades, our laboratory has accumulated significant expertise using several tests described above to evaluate autonomic control of heart rate, now focusing on various pathophysiological clinical conditions. The effect of endurance physical training and of aging was mostly focused on studies of normal volunteers whose responses at baseline served as controls to be compared during tests employed in individuals with some morbid clinical conditions. By far, the pathophysiology of Chagas heart disease involving the autonomic nervous system was the most predominant subject studied in our laboratory, since the early studies in the 1960s until the late studies just recently published in international journals (Central Illustration). Other pathological conditions focused on our studies were mitral valve prolapse, heart failure, post-cardiac surgery, and hyperthyroidism.

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Brief Communication

Heart Rate Reduction after Effort Test Is Higher in Physically Active Adults without Familial Cardiovascular Risk Factor

Larissa de Almeida Dourado et al. Paulo Magno Martins Dourado Jaciara Gomes de Oliveira Evandra Maria da Silva … João Paulo de Almeida Dourado Pedro Gabriel Senger Braga

Abstract

The objective of this study is to investigate the influence of physical activity on heart rate (HR) recovery, after treadmill exercise testing, in asymptomatic adults, with and without familial risk factors (FR) for cardiovascular disease. Two hundred and fifty (250) adults of both sexes aged 18 to 59 years were included in the study. None of the participants had a history of cardiovascular disease or used medications for chronic diseases. All individuals underwent exercise testing using the Ellestad protocol. Delta values were calculated by subtracting peak HR from HR in the first, second, fourth, and sixth minutes of recovery. The family history of cardiovascular disease and physical activity were documented. For statistical analysis, ANOVA was performed, followed by Bonferroni or Kruskall-Wallis multiple comparisons, followed by Dunn’s multiple comparisons. The delta values at the first, second, fourth, and sixth minutes of recovery were lower in individuals who did not engage in physical activity and had no family cardiovascular risk factor, compared to those who were physically active and had no family risk factor. No differences in delta values were observed between physically active individuals with cardiovascular risk factors and physically inactive individuals with a family history at the time points studied. In individuals without a family risk factor, physical activity appears to enhance autonomic control, increasing the capacity to reduce HR after exercise. However, this effect was not evident in those with a family risk factor, as physical activity did not impact recovery HR.

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Original Article

Sleep Quality Associated with Habitual Physical Activity Level and Autonomic Nervous System of Smokers

Iara Buriola Trevisan et al. Luiz Carlos Marques Vanderlei Mahara Proença Tiago V. Barreira … Caroline Pereira Santos Tamara Santos Gouveia Ercy Mara Cipulo Ramos Dionei Ramos

Abstract

Background

Few studies have examined the relationship of one’s habitual physical activity level and autonomic nervous system (ANS) modulation on sleep quality in smokers.

Objective

The aim of this study was to identify changes in the sleep quality of smokers and its relation with their habitual physical activity level and ANS modulation.

Methods

Forty-two smokers were divided into two groups according to the 50th percentile of the moderate-to-vigorous physical activity (MVPA). Sleep quality was assessed using the Mini-sleep Questionnaire, and ANS modulation was assessed by indices of heart rate variability (HRV). To examine the possible mean differences, the analysis of covariance (ANCOVA) was used, adjusted for age, sex, body composition, pack-years, beta-blockers, anxiety, and depression in log base 10, not including qualitative data, such as sex and beta-blockers. Correlations were made by using the Spearman rank correlation. The statistical significance was set at 5%

Results

The smokers who were less active showed poor sleep quality (p=0.048) and insomnia (p=0.045). Furthermore, the less active group presented decreased parasympathetic modulation [HF (un; p=0.049); RMSSD (ms; p=0.047) and SD1 (ms; p=0.047)] and an increased LF (un) index (p=0.033) and LF/HF ratio (p=0.040). A positive correlation between the total Mini-sleep score with LF (un) index (r=0.317, p=0.041) and LF/HF ratio (r=0.318, p=0.040) and negative correlation with HF (un) index (r= -0.322, p=0.038).

Conclusions

Smokers with lower levels of habitual physical activity showed poor sleep quality and alterations in autonomic nervous system modulation; (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

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Editorial

How to Evaluate Cardiac Autonomic Modulation

Esteban W. Rivarola et al. Mauricio I. Scanavacca

Cardiac autonomic nervous system dysfunction has been implicated in several different pathological scenarios with a wide range of clinical relevance and risk. Early detection of autonomic changes, either provoked for therapeutic purposes or as a complication of a primary disorder, such as diabetes mellitus (DM) is of essence for the best management of patients.

Classic (linear) analysis of heart rate variability (HRV) has been routinely used to assess autonomic behavior in diabetic patients in order to promptly detect neuropathy, one of the most common and overlooked complications and a significant cardiovascular risk factor.

[…]

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I – Evaluation of Cardiovascular Autonomic Function in Healthy Individuals

Abstract

II – Evaluation of Autonomic Control of Heart Rate in Various Clinical Conditions

Abstract

Heart Rate Reduction after Effort Test Is Higher in Physically Active Adults without Familial Cardiovascular Risk Factor

Abstract

Sleep Quality Associated with Habitual Physical Activity Level and Autonomic Nervous System of Smokers

Abstract

Background

Objective

Methods

Results

Conclusions

How to Evaluate Cardiac Autonomic Modulation

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