Cardiovascular Variability Analysis and Baroreflex Estimation in Patients with Type 2 Diabetes in Absence of Any Manifest Neuropathy

Moura, Sílvia Cristina Garcia de; Porta, Alberto; Marchi, Andrea; Fagundes, Alessandra de Almeida; Francisco, Cristina de Oliveira; Rehder-Santos, Patrícia; Milan‐Mattos, Juliana Cristina; Simões, Rodrigo Polaquini; Góis, Mariana de Oliveira; Catai, Aparecida Maria

doi:10.1371/journal.pone.0148903

Cited by 35 publications

(24 citation statements)

References 34 publications

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“…Although these altered hemodynamic responses are evident in T2DM, the effects of T2DM on the reflexive control of circulation during exercise are not completely understood. Currently, the effects of T2DM on baroreflex control are inconclusive (8,21). However, a recent study reported that patients with T2DM had increased muscle sympathetic nerve activity (MSNA) and augmented blood pressure responses to isometric handgrip exercise, a response which was maintained during post-exercise occlusion, suggesting that the metaboreflex was exaggerated in patients with T2DM (20).…”

Section: Introductionmentioning

confidence: 99%

Exaggerated cardiovascular responses to muscle contraction and tendon stretch in UCD type-2 diabetes mellitus rats

Grotle

Crawford

Huo

et al. 2019

American Journal of Physiology-Heart and Circulatory Physiology

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Patients with type-2 diabetes mellitus (T2DM) have exaggerated sympathetic activity and blood pressure responses to exercise. However, the underlying mechanisms for these responses, as well as how these responses change throughout disease progression, are not completely understood. For this study, we examined the effect of the progression of T2DM on the exercise pressor reflex, a critical neurocardiovascular mechanism that functions to increase sympathetic activity and blood pressure during exercise. We also aimed to examine the effect of T2DM on reflexive cardiovascular responses to static contraction, as well as those responses to tendon stretch when an exaggerated exercise pressor reflex was present. We evoked the exercise pressor reflex and mechanoreflex by statically contracting the hindlimb muscles and stretching the Achilles tendon, respectively, for 30 s. We then compared pressor and cardioaccelerator responses in unanesthetized, decerebrated University of California Davis (UCD)-T2DM rats at 21 and 31 wk following the onset of T2DM to responses in healthy nondiabetic rats. We found that the pressor response to static contraction was greater in the 31-wk T2DM [change in mean arterial pressure (∆MAP) = 39 ± 5 mmHg] but not in the 21-wk T2DM (∆MAP = 24 ± 5 mmHg) rats compared with nondiabetic rats (∆MAP = 18 ± 2 mmHg; P < 0.05). Similarly, the pressor and the cardioaccelerator responses to tendon stretch were significantly greater in the 31-wk T2DM rats [∆MAP = 69 ± 6 mmHg; change in heart rate (∆HR) = 28 ± 4 beats/min] compared with nondiabetic rats (∆MAP = 14 ± 2 mmHg; ∆HR = 5 ± 3 beats/min; P < 0.05). These findings suggest that the exercise pressor reflex changes as T2DM progresses and that a sensitized mechanoreflex may play a role in exaggerating these cardiovascular responses. NEW & NOTEWORTHY This is the first study to provide evidence that as type-2 diabetes mellitus (T2DM) progresses, the exercise pressor reflex becomes exaggerated, an effect that may be due to a sensitized mechanoreflex. Moreover, these findings provide compelling evidence suggesting that impairments in the reflexive control of circulation contribute to exaggerated blood pressure responses to exercise in T2DM.

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Section: Introductionmentioning

confidence: 99%

Exaggerated cardiovascular responses to muscle contraction and tendon stretch in UCD type-2 diabetes mellitus rats

Grotle

Crawford

Huo

et al. 2019

American Journal of Physiology-Heart and Circulatory Physiology

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“…Those data showed a decreased vagal tone and an increased sympathetic tone in the SHR, which were partially restored after the treatment with kefir for 60 days [46]. The magnitude of the kefir effect on the autonomic control of the heart was similar to that obtained by other interventions [54,[58][59][60]. The challenge is now to design new studies aiming to determine if the origin of the abnormality is located at central areas or peripheral nerves/receptors.…”

Section: Kefir and Autonomic Neural Control Of Cardiovascular Functionmentioning

confidence: 52%

Mechanisms of Action of Kefir in Chronic Cardiovascular and Metabolic Diseases

Pimenta

Luaces-Regueira

Ton

et al. 2018

Cell Physiol Biochem

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The gut microbiota maintains a complex mutual interaction with different organs of the host. Whereas in normal conditions this natural community of trillions of microorganisms greatly contributes to the human health, gut dysbiosis is related with onset or worsening of diverse chronic systemic diseases. Thus, the reestablishment of gut microbiota homeostasis with consumption of prebiotics and probiotics may be a relevant strategy to prevent or attenuate several cardiovascular and metabolic complications. Among these functional foods, the synbiotic kefir, which is a fermented milk composed of a mixture of bacteria and yeasts, is currently the most used and has attracted the attention of health care professionals. The present review is focused on reports describing the feasibility of kefir consumption to provide benefits in cardiometabolic diseases, including hypertension, vascular endothelial dysfunction, dyslipidemia and insulin resistance. Interestingly, recent studies show that mechanisms of actions of kefir in cardiometabolic diseases include recruitment of endothelial progenitor cells, improvement of the balance vagal/sympathetic nervous system, diminution of excessive generation of reactive oxygen species, angiotensin converting enzyme inhibition, anti-inflammatory cytokines profile and alteration of the intestinal microbiota. These findings provide a better understanding about the mechanisms of the beneficial actions of kefir and motivate further investigations to determine whether the use of this synbiotic could also be translated into clinical improvements in cardiometabolic diseases.

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“…Porta et al [ 16 ] proposed the non linear analysis of short term heart period variability, whose patterns are classified and divided into four families. The non linear analysis can detect nonreciprocal autonomic change [ 16 , 24 , 58 ]. We performed the first non-linear analysis of HRV in leprosy patients.…”

Section: Discussionmentioning

confidence: 99%

“…These results indicate that the control group has a greater predominance of vagal modulation, a greater HRV, and a greater complexity of cardiac autonomic modulation [ 16 , 24 ]. The change of position from the supine to the sitting position represents a stimulus, especially for the sympathetic modulation [ 14 , 16 , 24 , 58 , 60 ]. In the supine position, both autonomic systems have tonic activity with vagal modulation predominance that caused a high HRV while the sitting position had a sympathetic modulation prevalence and led to the decrease of the HRV [ 37 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Heart rate variability in multibacillar leprosy: Linear and nonlinear analysis

et al. 2017

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ObjectiveTo evaluate the heart rate variability (HRV) in patients with multibacillary leprosy using dynamic linear and nonlinear analysis.Material and methodsTwenty-one leprosy patients (mean age: 39.14 ±10.58 years) and 21 healthy subjects (mean age: 36.24 ± 12.64 years) completed the sample. Heart rate variability recording was performed by a Polar RS800 CX heart monitor during a period of 15 min in the supine position and 15 min in a sitting position. Analysis of HRV was performed by frequency domain from high frequency (HF) and low frequency (LF) spectral indexes in absolute and normalized units. The nonlinear analysis of HRV was calculated using symbolic analysis (0V%, 1V%, 2LV% and 2UV% indexes), Shannon entropy (SE) and normalized complexity index (NCI).ResultsLinear analysis: both groups showed higher HF values (p < 0.05) and smaller LF values (p < 0.05) in supine than in sitting position. The leprosy patients showed higher LF values (p < 0.05) and smaller HF values (p < 0.05) compared to the controls on supine position. Symbolic analysis: leprosy patients had higher 0V% values (p < 0.05), smaller 2LV% values (p < 0.05) and 2UV % values compared to healthy subjects on both positions. The 1V % had higher values (p < 0.05) for leprosy patients than for controls in the sitting position. The control subjects had smaller 0V % values (p < 0.05), and higher 2UV % values (p < 0.05) in the supine position compared to the sitting position. Leprosy patients had higher 2UV index values (p < 0.05) in the supine position compared to the sitting position. In the complexity analysis, leprosy patients had smaller SE and NCI values (p < 0.05) than the control in the supine position. There was no difference between the SE and NCI values of leprosy and the control subjects in the sitting position. The control subjects had higher SE and NCI values (p < 0.05) in the supine position than in the sitting position.ConclusionLeprosy patients had higher sympathetic modulation and smaller vagal modulation than controls, indicating less HRV and cardiac modulation with lower complexity. The control group displayed significant HRV differences in response to position changes while leprosy patients had fewer HRV differences after the same postural change. An analysis of HRV with linear and non-linear dynamics proved to be a reliable method and promising for the investigation of autonomic dysfunction in patients with multibacillary leprosy.

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Cardiovascular Variability Analysis and Baroreflex Estimation in Patients with Type 2 Diabetes in Absence of Any Manifest Neuropathy

Cited by 35 publications

References 34 publications

Exaggerated cardiovascular responses to muscle contraction and tendon stretch in UCD type-2 diabetes mellitus rats

Exaggerated cardiovascular responses to muscle contraction and tendon stretch in UCD type-2 diabetes mellitus rats

Mechanisms of Action of Kefir in Chronic Cardiovascular and Metabolic Diseases

Heart rate variability in multibacillar leprosy: Linear and nonlinear analysis

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