Cardiovascular control in women with fibromyalgia syndrome: do causal methods provide nonredundant information compared with more traditional approaches?

Zamunér, Antônio Roberto; Porta, Alberto; Andrade, Carolina Pieroni; Marchi, Andrea; Forti, Meire; Furlan, Raffaello; Barbic, Franca; Catai, Aparecida Maria; Silva, Ester

doi:10.1152/ajpregu.00012.2015

Cited by 17 publications

(22 citation statements)

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“…Our finding that cBRS decreased with active and passive standing postures compared to the lying position (Table 1, Figure 4C) agrees with previous work (Steptoe and Vögele, 1990; O'Leary et al, 2003; Nollo et al, 2005; Faes et al, 2013; Schwartz et al, 2013; Zamunér et al, 2015). Moreover, our finding that cBRS in the supine position significantly decreased after the loss of more than 0.33 L of blood is in line with previous reports (Hughson et al, 1994; Saitoh et al, 2008) obtained using lower-body negative pressure, which also decreases CVP in the supine position.…”

Section: Discussionsupporting

confidence: 91%

“…A set of analysis techniques based on information theory (Nollo et al, 2005; Porta et al, 2011, 2014, 2015; Faes et al, 2013; Zamunér et al, 2015) has been applied to infer the direction and strength of causal links between the time series of SAP and HP. A rather straightforward interpretation of causality is afforded by these techniques at the expense of significant computational and theoretical complexity.…”

Section: Discussionmentioning

confidence: 99%

“…Standing upright produces an exaggerated fall of arterial pressure in patients with bilateral carotid sinus denervation consequent to carotid body tumor resection, suggesting a key role of carotid baroreceptors in the hemodynamic compensation of upright posture (Smit et al, 2002). Accordingly, the analysis of spontaneous cardiovascular fluctuations, performed with a range of techniques designed to detect causality based on information theory, indicates that the upright posture increases the contribution of the arterial baroreflex to cardiac control (Nollo et al, 2005; Porta et al, 2011, 2014, 2015; Faes et al, 2013; Zamunér et al, 2015). Somewhat paradoxically, however, the cardiac baroreflex sensitivity (cBRS) estimated based on spontaneous fluctuations decreases in the upright position (Steptoe and Vögele, 1990; O'Leary et al, 2003; Nollo et al, 2005; Faes et al, 2013; Schwartz et al, 2013; Zamunér et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

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Physiological Mechanisms Mediating the Coupling between Heart Period and Arterial Pressure in Response to Postural Changes in Humans

et al. 2017

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The upright posture strengthens the coupling between heart period (HP) and systolic arterial pressure (SAP) consistently with a greater contribution of the arterial baroreflex to cardiac control, while paradoxically decreasing cardiac baroreflex sensitivity (cBRS). To investigate the physiological mechanisms that mediate the coupling between HP and SAP in response to different postures, we analyzed the cross-correlation functions between low-frequency HP and SAP fluctuations and estimated cBRS with the sequence technique in healthy male subjects during passive head-up tilt test (HUTT, n = 58), during supine wakefulness, supine slow-wave sleep (SWS), and in the seated and active standing positions (n = 8), and during progressive loss of 1 L blood (n = 8) to decrease central venous pressure in the supine position. HUTT, SWS, the seated, and the standing positions, but not blood loss, entailed significant increases in the positive correlation between HP and the previous SAP values, which is the expected result of arterial baroreflex control, compared with baseline recordings in the supine position during wakefulness. These increases were mirrored by increases in the low-frequency variability of SAP in each condition but SWS. cBRS decreased significantly during HUTT, in the seated and standing positions, and after blood loss compared with baseline during wakefulness. These decreases were mirrored by decreases in the RMSSD index, which reflects cardiac vagal modulation. These results support the view that the cBRS decrease associated with the upright posture is a byproduct of decreased cardiac vagal modulation, triggered by the arterial baroreflex in response to central hypovolemia. Conversely, the greater baroreflex contribution to cardiac control associated with upright posture may be explained, at least in part, by enhanced fluctuations of SAP, which elicit a more effective entrainment of HP fluctuations by the arterial baroreflex. These SAP fluctuations may result from enhanced fluctuations of vascular resistance specific to the upright posture, and not be driven by the accompanying central hypovolemia.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Physiological Mechanisms Mediating the Coupling between Heart Period and Arterial Pressure in Response to Postural Changes in Humans

et al. 2017

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“…As a consequence, autonomic function and cardiovascular control have been frequently assessed in FMS and their evaluation has been typically based on the analysis of spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP) [2–6]. These studies have reported that patients with FMS feature an increased sympathetic control and a reduced vagal modulation in supine position at rest (REST) [4,7,8], a lower cardiac baroreflex sensitivity compared to age-matched healthy subjects at REST [4,7,8], an inability of reducing further baroreflex sensitivity during an orthostatic challenge such as active standing (STAND) [6] and a limited involvement of the baroreflex control in regulating arterial blood pressure during STAND as detected by Granger causality analysis [6]. However, whether all these parameters derived from HP and SAP variabilities are related to the quality of life of the FMS patient, as assessed from a clinical score such as the fibromyalgia impact questionnaire (FIQ) and the visual analog score for pain (VAS pain), is unknown.…”

Section: Introductionmentioning

confidence: 99%

The degree of cardiac baroreflex involvement during active standing is associated with the quality of life in fibromyalgia patients

et al. 2017

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Fibromyalgia syndrome (FMS) is a rheumatologic disorder characterized by chronic widespread pain, fatigue and other symptoms. Baroreflex dysfunction has been observed in women with FMS. However, it is unknown whether the limited involvement of the baroreflex control during an orthostatic stimulus has some impact on the quality of life of the FMS patient. Therefore, the aim of the study is evaluate the relationship between the quality of life of the FMS patient and indexes of the cardiovascular autonomic control as estimated from spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP). We enrolled 35 women with FMS (age: 48.8±8.9 years; body mass index: 29.3±4.3 Kg/m2). The electrocardiogram, non-invasive finger blood pressure and respiratory activity were continuously recorded during 15 minutes at rest in supine position (REST) and in orthostatic position during active standing (STAND). Traditional cardiovascular autonomic control markers were assessed along with a Granger causality index assessing the strength of the causal relation from SAP to HP (CRSAP→HP) and measuring the degree of involvement of the cardiac baroreflex. The impact of FMS on quality of life was quantified by the fibromyalgia impact questionnaire (FIQ) and visual analog score for pain (VAS pain). No significant linear association was found between FIQ scores and the traditional cardiovascular indexes both at REST and during STAND (p>0.05). However, a negative relationship between CRSAP→HP during STAND and FIQ score was found (r = -0.56, p<0.01). Similar results were found with VAS pain. In conclusion, the lower the degree of cardiac baroreflex involvement during STAND in women with FMS, the higher the impact of FMS on the quality of life, thus suggesting that Granger causality analysis might be clinically helpful in assessing the state of the FMS patient.

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“…[1][2][3] Recent studies have used the active standing test to assess the cardiovascular autonomic control responses to the orthostatic stimulus in several disorders, including FMS. 4 However, there are few studies correlating symptoms and clinical factors with cardiovascular autonomic dysfunction. Objectives: To assess the relationship between the impact of fibromyalgia on quality of life and cardiac autonomic control response to the active standing test.…”

Section: St Vincents University Hospital Dublin Irelandmentioning

confidence: 99%

FRI0614-HPR Delayed Diagnosis, Pain and Loss of Function Are Some of The Consequences of Spontaneous Fractures in Patients with Rheumatoid Arthritis – A Qualitative Analysis of Patients' Experience

Rasmussen¹,

Melgaard²,

Yurtsever

et al. 2016

Ann Rheum Dis

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BackgroundSpontaneous fractures in patients with rheumatoid arthritis (RA) have only occasionally been reported in the literature1,2. However, rheumatologists at Vendsyssel Hospital have noticed several cases where new onset knee or ankle pain was misdiagnosed as arthritis activity but was later shown to be spontaneous fractures. An x-ray examination did not reveal the fracture, but it was identified on an MRI examination. The fractures are at risk of being overlooked, and this fact may lead to a delay in diagnosis and a risk of ineffective treatment with e.g. steroid injections.ObjectivesThe study was carried out in the Physio- and Occupational Therapist unit in Vendsyssel Hospital. The included patients were diagnosed with RA and spontaneous fractures. Fifteen patients, all women, were identified. Ten patients in the age of 57–88 years participated in the study. They had an average disease duration of 14.2 years and a MRI was performed at a median of eight months.MethodsThe patients were divided into two age specific groups: 57–69 and 70–88 years. The focus groups data were subjected to thematic analysis to provide a sense of the important themes. Categorizing, coding and analysing the data from the focus groups identified the themes.ResultsAll patients identified the missing diagnosis as a significant burden. The patients were experiencing pain, but did not receive a diagnosis or an explanation for their symptoms. “I've never been as happy as when I was told my leg was broken …” Most of the patients experienced more pain than usual for their RA: ”You suddenly have a lot more pain, but you just don't know where it comes from”. All patients noticed a significant loss of function before the diagnosis was made and during immobilisation: ”I was so unhappy about not being able to do anything … even just getting up at night to go to the toilet …”. When the patients were immobilised they were offered crutches, but they were not able to use standard crutches due to their RA: ”I can't use crutches because I don't have enough strength to lift myself…”ConclusionsPatients with RA with spontaneous fractures experience the delayed diagnosis as a burden, and it is stressful for them to wait for an explanation for their pain. Due to the patients missing ability to use crutches or use a wheelchair, it is important to find other aids that patients with RA and spontaneous fractures can use. When the patients were immobilised they experienced loss of function. This calls for the need to focus on the diagnosis and guidance of these patients in relation to daily activities and aids.ReferencesHauser B, Riches PL, Wilson JF, Horne AE, Ralston SH. Prevalence and clinical prediction of osteoporosis in a contemporary cohort of patients with rheumatoid arthritis. Rheumatology 2014; 53:1759–66Spina A, Clemente A, Vancini C, Fejzo M, Campioni P. Musculoskeletal Radiology: Spontaneous talar and calcaneal fracture in rheumatoid arthritis: a case report. Radiology Case 2011; 5(7): 15–23Disclosure of InterestNone declared

show abstract

Cardiovascular control in women with fibromyalgia syndrome: do causal methods provide nonredundant information compared with more traditional approaches?

Cited by 17 publications

References 28 publications

Physiological Mechanisms Mediating the Coupling between Heart Period and Arterial Pressure in Response to Postural Changes in Humans

Physiological Mechanisms Mediating the Coupling between Heart Period and Arterial Pressure in Response to Postural Changes in Humans

The degree of cardiac baroreflex involvement during active standing is associated with the quality of life in fibromyalgia patients

FRI0614-HPR Delayed Diagnosis, Pain and Loss of Function Are Some of The Consequences of Spontaneous Fractures in Patients with Rheumatoid Arthritis – A Qualitative Analysis of Patients' Experience

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