Document Detail


Frequency analysis unveils cardiac autonomic dysfunction after mild traumatic brain injury.
MedLine Citation:
PMID:  21355816     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Long-term mortality is increased after mild traumatic brain injury (mTBI). Central cardiovascular-autonomic dysregulation resulting from subtle, trauma-induced brain lesions might contribute to cardiovascular events and fatalities. We investigated whether there is cardiovascular-autonomic dysregulation after mTBI. In 20 mTBI patients (37±13 years, 5-43 months post-injury) and 20 healthy persons (26±9 years), we monitored respiration, RR-intervals (RRI), blood pressures (BP), while supine and upon standing. We calculated the root mean square successive RRI differences (RMSSD) reflecting cardiovagal modulation, the ratio of maximal and minimal RRIs around the 30th and 15th RRI upon standing (30:15 ratio) reflecting baroreflex-sensitivity (BRS), spectral powers of parasympathetic high-frequency (HF: 0.15-0.5 Hz) RRI-oscillations, of mainly sympathetic low-frequency (LF: 0.04-0.15 Hz) RRI-oscillations, of sympathetic LF-BP-oscillations, RRI-LF/HF-ratios reflecting sympatho-vagal balance, and the gain between BP- and RRI-oscillations as additional BRS-index (BRSgain). We compared supine and standing parameters of patients and controls (repeated-measures-analysis-of-variance; significance: P<0.05). While supine, patients had lower RRIs (874.2±157.8 vs. 1024.3±165.4 ms), RMSSDs (30.1±23.6 vs. 56.3±31.4 ms), RRI-HF-powers (298.1±309.8 vs. 1507.2±1591.4 ms2), BRSgain (8.1±4.4 vs. 12.5 ± 8.1 ms·mmHg-1), but higher RRI-LF/HF-ratios (3.0±1.9 vs. 1.2±0.7) than controls. Upon standing, RMSSDs and RRI-HF-powers decreased significantly in controls, but not in patients; patients had lower RRI-30:15-ratios (1.3±0.3 vs. 1.6±0.3) and RRI-LF-powers (2450.0±2110.3 vs. 4805.9±3453.5 ms2) than controls. While supine, mTBI patients had reduced cardiovagal modulation and BRS. Upon standing, their BRS was still reduced, and patients did not withdraw parasympathetic nor augment sympathetic modulation adequately. Impaired autonomic modulation likely contributes to cardiovascular irregularities post mTBI.
Authors:
Max J Hilz; Philip A Defina; Stefan Anders; Julia Koehn; Christoph J Lang; Elisabeth Pauli; Steven R Flanagan; Stefan Schwab; Harald Marthol
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-1
Journal Detail:
Title:  Journal of neurotrauma     Volume:  -     ISSN:  1557-9042     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8811626     Medline TA:  J Neurotrauma     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
New York University School of Medicine, Deptartments of Neurology, Medicine and Psychiatry, 550 First Avenue, Suite NB 7W11, New York, New York, United States, 10016, +1-212-686-7500 ext. 7755, +1-212-951-3441; max.hilz@nyumc.org.
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