Baroreflex gain predicts blood pressure recovery during simulated ventricular tachycardia in humans

Mohamed H. Hamdan, Jose A. Joglar, Richard L. Page, Jason D. Zagrodzky, Clifford J. Sheehan, Stephen L. Wasmund, Michael L. Smith

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background - Despite similar degrees of left ventricular dysfunction and similar tachycardia or pacing rate, blood pressure (BP) response and symptoms vary greatly among patients. Sympathetic nerve activity (SNA) increases during sustained ventricular tachycardia (VT), and the magnitude of this sympathoexcitatory response appears to contribute to the net hemodynamic outcome. We hypothesize that the magnitude of sympathoexcitation and thus arterial baroreflex gain is an important determinant of the hemodynamic outcome of VT. Methods and Results - We evaluated the relation between arterial baroreflex sympathetic gain and BP recovery during rapid ventricular pacing (VP) in patients referred for electrophysiological study. Efferent postganglionic muscle SNA, BP, and central venous pressure (CVP) were measured in 14 patients during nitroprusside infusion and during VP at 150 (n= 12) or 120 (n=2) bpm. Arterial baroreflex gain was defined as the slope of the relationship of change in SNA to change in diastolic BP during nitroprusside infusion. Recovery of mean arterial pressure (MAP) during VP was measured as the increase in MAP from the nadir at the onset of pacing to the steady-state value during sustained VP. Arterial baroreflex gain correlated positively with recovery of MAP (r=0.57, P=0.034). No significant correlation between ejection fraction and baroreflex gain (r=0.48, P=0.08) or BP recovery (r=0.41, P=0.15) was found. When patients were separated into high versus low baroreflex gain, the recovery of MAP during simulated VT was significantly greater in patients with high gain. Conclusions - These data strongly suggest that arterial baroreflex gain contributes significantly to hemodynamic stability during simulated VT. Knowledge of baroreflex gain in individual patients may help the clinician tailor therapy directed toward sustained VT.

Original languageEnglish (US)
Pages (from-to)381-386
Number of pages6
JournalCirculation
Volume100
Issue number4
StatePublished - Jul 27 1999

Fingerprint

Baroreflex
Ventricular Tachycardia
Blood Pressure
Arterial Pressure
Hemodynamics
Nitroprusside
Central Venous Pressure
Left Ventricular Dysfunction
Tachycardia
Muscles

Keywords

  • Nervous system, autonomic
  • Tachycardia
  • Ventricles

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Hamdan, M. H., Joglar, J. A., Page, R. L., Zagrodzky, J. D., Sheehan, C. J., Wasmund, S. L., & Smith, M. L. (1999). Baroreflex gain predicts blood pressure recovery during simulated ventricular tachycardia in humans. Circulation, 100(4), 381-386.

Baroreflex gain predicts blood pressure recovery during simulated ventricular tachycardia in humans. / Hamdan, Mohamed H.; Joglar, Jose A.; Page, Richard L.; Zagrodzky, Jason D.; Sheehan, Clifford J.; Wasmund, Stephen L.; Smith, Michael L.

In: Circulation, Vol. 100, No. 4, 27.07.1999, p. 381-386.

Research output: Contribution to journalArticle

Hamdan, MH, Joglar, JA, Page, RL, Zagrodzky, JD, Sheehan, CJ, Wasmund, SL & Smith, ML 1999, 'Baroreflex gain predicts blood pressure recovery during simulated ventricular tachycardia in humans', Circulation, vol. 100, no. 4, pp. 381-386.
Hamdan MH, Joglar JA, Page RL, Zagrodzky JD, Sheehan CJ, Wasmund SL et al. Baroreflex gain predicts blood pressure recovery during simulated ventricular tachycardia in humans. Circulation. 1999 Jul 27;100(4):381-386.
Hamdan, Mohamed H. ; Joglar, Jose A. ; Page, Richard L. ; Zagrodzky, Jason D. ; Sheehan, Clifford J. ; Wasmund, Stephen L. ; Smith, Michael L. / Baroreflex gain predicts blood pressure recovery during simulated ventricular tachycardia in humans. In: Circulation. 1999 ; Vol. 100, No. 4. pp. 381-386.
@article{4156ca4db0824fa4a5e97ea294c312eb,
title = "Baroreflex gain predicts blood pressure recovery during simulated ventricular tachycardia in humans",
abstract = "Background - Despite similar degrees of left ventricular dysfunction and similar tachycardia or pacing rate, blood pressure (BP) response and symptoms vary greatly among patients. Sympathetic nerve activity (SNA) increases during sustained ventricular tachycardia (VT), and the magnitude of this sympathoexcitatory response appears to contribute to the net hemodynamic outcome. We hypothesize that the magnitude of sympathoexcitation and thus arterial baroreflex gain is an important determinant of the hemodynamic outcome of VT. Methods and Results - We evaluated the relation between arterial baroreflex sympathetic gain and BP recovery during rapid ventricular pacing (VP) in patients referred for electrophysiological study. Efferent postganglionic muscle SNA, BP, and central venous pressure (CVP) were measured in 14 patients during nitroprusside infusion and during VP at 150 (n= 12) or 120 (n=2) bpm. Arterial baroreflex gain was defined as the slope of the relationship of change in SNA to change in diastolic BP during nitroprusside infusion. Recovery of mean arterial pressure (MAP) during VP was measured as the increase in MAP from the nadir at the onset of pacing to the steady-state value during sustained VP. Arterial baroreflex gain correlated positively with recovery of MAP (r=0.57, P=0.034). No significant correlation between ejection fraction and baroreflex gain (r=0.48, P=0.08) or BP recovery (r=0.41, P=0.15) was found. When patients were separated into high versus low baroreflex gain, the recovery of MAP during simulated VT was significantly greater in patients with high gain. Conclusions - These data strongly suggest that arterial baroreflex gain contributes significantly to hemodynamic stability during simulated VT. Knowledge of baroreflex gain in individual patients may help the clinician tailor therapy directed toward sustained VT.",
keywords = "Nervous system, autonomic, Tachycardia, Ventricles",
author = "Hamdan, {Mohamed H.} and Joglar, {Jose A.} and Page, {Richard L.} and Zagrodzky, {Jason D.} and Sheehan, {Clifford J.} and Wasmund, {Stephen L.} and Smith, {Michael L.}",
year = "1999",
month = "7",
day = "27",
language = "English (US)",
volume = "100",
pages = "381--386",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Baroreflex gain predicts blood pressure recovery during simulated ventricular tachycardia in humans

AU - Hamdan, Mohamed H.

AU - Joglar, Jose A.

AU - Page, Richard L.

AU - Zagrodzky, Jason D.

AU - Sheehan, Clifford J.

AU - Wasmund, Stephen L.

AU - Smith, Michael L.

PY - 1999/7/27

Y1 - 1999/7/27

N2 - Background - Despite similar degrees of left ventricular dysfunction and similar tachycardia or pacing rate, blood pressure (BP) response and symptoms vary greatly among patients. Sympathetic nerve activity (SNA) increases during sustained ventricular tachycardia (VT), and the magnitude of this sympathoexcitatory response appears to contribute to the net hemodynamic outcome. We hypothesize that the magnitude of sympathoexcitation and thus arterial baroreflex gain is an important determinant of the hemodynamic outcome of VT. Methods and Results - We evaluated the relation between arterial baroreflex sympathetic gain and BP recovery during rapid ventricular pacing (VP) in patients referred for electrophysiological study. Efferent postganglionic muscle SNA, BP, and central venous pressure (CVP) were measured in 14 patients during nitroprusside infusion and during VP at 150 (n= 12) or 120 (n=2) bpm. Arterial baroreflex gain was defined as the slope of the relationship of change in SNA to change in diastolic BP during nitroprusside infusion. Recovery of mean arterial pressure (MAP) during VP was measured as the increase in MAP from the nadir at the onset of pacing to the steady-state value during sustained VP. Arterial baroreflex gain correlated positively with recovery of MAP (r=0.57, P=0.034). No significant correlation between ejection fraction and baroreflex gain (r=0.48, P=0.08) or BP recovery (r=0.41, P=0.15) was found. When patients were separated into high versus low baroreflex gain, the recovery of MAP during simulated VT was significantly greater in patients with high gain. Conclusions - These data strongly suggest that arterial baroreflex gain contributes significantly to hemodynamic stability during simulated VT. Knowledge of baroreflex gain in individual patients may help the clinician tailor therapy directed toward sustained VT.

AB - Background - Despite similar degrees of left ventricular dysfunction and similar tachycardia or pacing rate, blood pressure (BP) response and symptoms vary greatly among patients. Sympathetic nerve activity (SNA) increases during sustained ventricular tachycardia (VT), and the magnitude of this sympathoexcitatory response appears to contribute to the net hemodynamic outcome. We hypothesize that the magnitude of sympathoexcitation and thus arterial baroreflex gain is an important determinant of the hemodynamic outcome of VT. Methods and Results - We evaluated the relation between arterial baroreflex sympathetic gain and BP recovery during rapid ventricular pacing (VP) in patients referred for electrophysiological study. Efferent postganglionic muscle SNA, BP, and central venous pressure (CVP) were measured in 14 patients during nitroprusside infusion and during VP at 150 (n= 12) or 120 (n=2) bpm. Arterial baroreflex gain was defined as the slope of the relationship of change in SNA to change in diastolic BP during nitroprusside infusion. Recovery of mean arterial pressure (MAP) during VP was measured as the increase in MAP from the nadir at the onset of pacing to the steady-state value during sustained VP. Arterial baroreflex gain correlated positively with recovery of MAP (r=0.57, P=0.034). No significant correlation between ejection fraction and baroreflex gain (r=0.48, P=0.08) or BP recovery (r=0.41, P=0.15) was found. When patients were separated into high versus low baroreflex gain, the recovery of MAP during simulated VT was significantly greater in patients with high gain. Conclusions - These data strongly suggest that arterial baroreflex gain contributes significantly to hemodynamic stability during simulated VT. Knowledge of baroreflex gain in individual patients may help the clinician tailor therapy directed toward sustained VT.

KW - Nervous system, autonomic

KW - Tachycardia

KW - Ventricles

UR - http://www.scopus.com/inward/record.url?scp=0033609532&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033609532&partnerID=8YFLogxK

M3 - Article

VL - 100

SP - 381

EP - 386

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 4

ER -