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Cited by 35Heart Rate Variability and Autonomic ControlCardiovascular Syncope and Autonomic DisordersCardiac electrophysiology and arrhythmias

Impaired baroreflex gain in patients with inappropriate sinus tachycardia

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LEON, HERNANDO, GUZMAN, JUAN CAMILO, KUUSELA, TOM, DILLENBURG, REJANE, KAMATH, MARK, MORILLO, CARLOS A.·2005·Journal of Cardiovascular Electrophysiology
DOI 10.1046/j.1540-8167.2005.04441.x
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Abstract

Introduction: The aim of this study was to determine the characteristics of heart rate variability (HRV), blood pressure variability (BPV), and baroreflex gain (BRG) at rest and during orthostatic stress in patients with clinical criteria of inappropriate sinus tachycardia (IST). Methods and Results: Beat‐to‐beat HRV and BPV, measured by time‐ and frequency‐domain methods, and noninvasive BRG, calculated by cross‐spectral analysis, were obtained during 10 minutes both at rest and during the stabilization phase (5–15 min) of orthostatic stress at 60° in 8 patients with clinical criteria of IST and 9 healthy volunteers (CON). IST patients had a higher resting mean heart rate (78.8 ± 5.3 vs 58.5 ± 4.2 beats/min, P = 0.01) and mean blood pressure (90.4 ± 2.4 vs 72.0 ± 4.2 mmHg; P = 0.002). RMSSD, pNN50m, and BRG were significantly reduced in IST patients at rest. BRG during orthostatic stress (7.2 ± 0.8 vs 20.3 (2.4 ms/mmHg, P < 0.01) was significantly reduced in IST patients. Δ BRG (−16.9%± 11 vs −50.1%± 5, P = 0.02) was markedly blunted during orthostatic stress in IST patients. Conclusion: BRG was markedly impaired both at rest and during orthostatic stress in IST patients. This alteration may be responsible for the higher resting heart rate and mean blood pressures seen at rest and may facilitate tachycardia during orthostatic stress. A primary alteration in sinus node automaticity coupled with impaired BRG determines heart rate response to orthostatic stress in patients with IST.

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  • Present evidence suggests several potential mechanisms for IST, including an intrinsic sinus node issue, a beta-receptor stimulating autoantibody, beta-receptor supersensitivity, a muscarinic (M2) receptor abnormality, impaired baroreflex control, blunted response to adenosine, reduction in baroreflex gain, abnormalities in parasympathetic function, and vagal denervation.

    “Present evidence suggests several potential mechanisms including: an intrinsic sinus node issue 24 ; a beta-receptor stimulating autoantibody 25 ; betareceptor supersensitivity; a muscarinic (M2) receptor abnormality; impaired baroreflex control 26 ; blunted response to adenosine with or without autonomic blockade 27 ; reduction in and alteration of baroreflex gain and abnormalities in parasympat”

    From Inappropriate sinus tachycardia (2019) · cites this paper as [26]

  • Perturbations in autonomic regulation that may manifest as IST include diabetic autonomic neuropathy, baroreflex impairment, β-adrenergic receptor autoantibodies, and hyperadrenergic states such as pheochromocytoma.

    “Perturbations in autonomic regulation that may manifest as IST include diabetic autonomic neuropathy,59 baroreflex impairment,60 β-adrenergic receptor autoantibodies,61 and hyperadrenergic states such as pheochromocytoma62.”

    From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [60]

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Research works printed but not linked: 6

  1. [2]2. Morillo CA, Klein GJ, Thakur RK, Li HG, Zardini M, Yee R: Mecha- nisms of Inappropriate sinus tachycardia. Role of sympathovagal bal- ance. Circulation 1994;90:873-877.
  2. [3]3. Krahn AD, Yee R, Klein GJ, Morillo C: Inappropriate sinus tachycar- dia, evaluation and therapy. J Cardiovasc Electrophysiol 1995;6:1124- 1128.
  3. [5]5. Morillo CA, Leon H, Pava F: Is inappropriate sinus tachycardia really inappropriate. In Raviele A, ed: Cardiac Arrhythmias. Italy: Springer- Verlag, 2001, pp. 320-323.
  4. [6]6. La Rovere MT, Pinna GD, Mortara A: Assessment of baroreflex sen- sitivity. In Malik M, ed: Clinical Guide to Cardiac Autonomic Tests. Boston: Kluwer Academic Publishers, 1998, pp. 257-281.
  5. [15]15. Jose AD, Collinson D: The normal values of the intrinsic heart rate in man. Cardiovasc Res 1970;4:160-167.
  6. [19]19. Parati G, Saul JP, Di Rienzo M, Mancia G: Spectral analysis of blood pressure and heart rate variability in evaluating cardiovascular regula- tion. Hypertension 1995;25:1276-1295.

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Authors
LEON, H., GUZMAN, J. C., KUUSELA, T., DILLENBURG, R., KAMATH, M., & MORILLO, C. A.
Affiliations
  • University of Turku (FI)
  • McMaster University (CA)
  • Fundación Cardiovascular de Colombia (CO)
Corresponding author
MORILLO, CARLOS A.
ORCID
Venue
Journal of Cardiovascular Electrophysiology
Publisher
Wiley
Published
2005-01
Volume
16
Issue
1
Pages
64-68
ISSN
  • 1045-3873 (ISSN-L)
  • 1540-8167
DOI
10.1046/j.1540-8167.2005.04441.x
OpenAlex
W2007579025
Semantic Scholar
a3596ac01bdbf7d8dfd38b5045e8c6bb2f32b87c
Cited by
35
References
26
Citations by year
2025: 1 · 2022: 3 · 2021: 1 · 2020: 1 · 2019: 3 · 2018: 2 · 2016: 1 · 2015: 4 · 2014: 1 · 2013: 4 · 2012: 4
FWCI
1.14
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 16 d)
Locations
  • Journal of Cardiovascular Electrophysiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords
inappropriate sinus tachycardia, baroreflex gain, heart rate variability, blood pressure variability, orthostatic stress, sinus node automaticity, tachycardia, autonomic dysfunction
MeSH terms
Adaptation, Physiological, Adult, Blood Pressure, Dizziness, Exercise Test, Female, Heart Rate, Humans, Male, Posture, Tachycardia, Sinus, Baroreflex

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