ABSTRACT
BACKGROUND AND AIM OF THE STUDY: Left coronary dominance may be more prevalent in patients with valvular aortic stenosis (AS). A cohort study was conducted to: (i) determine the prevalence of coronary left dominance in patients with AS; (ii) assess if a possible higher prevalence of left dominance is confined to patients with bicuspid aortic valve; (iii) examine if left dominance is a risk factor for the progression of AS, independent of established risk factors; and (iv) assess in-hospital clinical outcome following valve replacement according to the coronary dominance pattern. METHODS: The prevalence of left coronary dominance was analyzed in 721 patients with severe isolated AS, and compared to a control cohort of 6,990 patients without AS. The clinical data and short-term outcome following valve replacement were assessed according to the coronary dominance pattern. RESULTS: Left coronary dominance was significantly more prevalent in patients with AS compared to those without AS (13.7% versus 10.2%, p = 0.003), and a pattern of right coronary dominance was less frequent in patients with AS (66.9% versus 71.6%, p = 0.008), irrespective of the presence of a bicuspid or tricuspid valve. Left coronary dominance was not an independent predictor of younger age at the time of valve replacement. There were no differences for in-hospital mortality and rates of myocardial infarction between coronary dominance types. CONCLUSION: Although left coronary dominance is more prevalent in patients with AS, it is not a risk factor for disease progression, and is not associated with short-term adverse outcome following valve replacement.
Subject(s)
Aortic Valve Stenosis/physiopathology , Aortic Valve/physiopathology , Coronary Circulation , Coronary Vessels/physiopathology , Age Factors , Aged , Aged, 80 and over , Aortic Valve/abnormalities , Aortic Valve/surgery , Aortic Valve Stenosis/mortality , Aortic Valve Stenosis/surgery , Case-Control Studies , Chi-Square Distribution , Coronary Vessels/surgery , Disease Progression , Female , Functional Laterality , Germany , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/mortality , Hospital Mortality , Humans , Linear Models , Male , Middle Aged , Myocardial Infarction/etiology , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Time Factors , Treatment OutcomeABSTRACT
Information on autonomic modulation can be derived from different organs that are innervated by the sympathetic and the parasympathetic nervous system, when assessing e.g. heart rate or blood pressure fluctuations or the pupil's reaction to light. Correlations between parameters from different target organs might reveal information on hierarchically higher centres of autonomic integration. Here, we obtained parameters of heart rate variability, blood pressure variability, baroreflex function and light reaction pupillography from 50 individuals and tested the hypothesis that these are associated. Pupil diameter and constriction latency significantly correlated with parameters of heart rate variability, but not with those of blood pressure variability. In contrast, relative amplitude significantly correlated with blood pressure variability only. In conclusion, the different branches of the autonomic nervous system examined here are not associated unequivocally but show a distinct pattern of interrelations in healthy subjects. Examinations as described here might add to the diagnosis of autonomic dysfunction and reveal differential patterns in certain disease states.
Subject(s)
Blood Pressure/physiology , Heart Rate/physiology , Reflex, Pupillary/physiology , Adult , Baroreflex/physiology , Electrocardiography , Entropy , Humans , Light , Middle Aged , Nonlinear Dynamics , Photic Stimulation , Pupil/physiology , Time Factors , Young AdultABSTRACT
OBJECTIVE: Cardiac autonomic dysregulation has been reported in patients with schizophrenia. However, there are no definite data examining whether other branches of the autonomic nervous system are compromised as well and how they interrelate with cardiac function. In this study, we tested the hypothesis that the autonomic dysregulation at the heart is reflected in the regulation of the pupillary light reflex. METHODS: We assessed heart rate variability and baroreflex sensitivity parameters as well as pupillographic measures in 28 unmedicated patients with schizophrenia and compared these measures to those of 28 controls. In addition, cardiovascular and pupillographic parameters were correlated in both groups. RESULTS: The obtained cardiovascular parameters indicated decreased parasympathetic modulation. Patients showed a significantly increased resting pupil diameter as well as reduced relative amplitude, suggesting a dominance of sympathetic control and a lack of parasympathetic modulation at the pupil. Intriguingly, the parasympathetic latency of the pupil constriction was similar in both groups and correlated with several cardiovascular parameters. These correlations were in the opposite direction in patients compared to controls. Furthermore, shorter latencies of the pupil constriction were associated with symptom severity in patients. CONCLUSIONS: Overall, we found evidence for an autonomic dysregulation at the pupil and heart in patients with schizophrenia. Future studies are warranted to describe this complex interaction at different levels of the autonomic system. SIGNIFICANCE: The interrelationship of both the systems indicates that the autonomic dysfunction affects the regulation in different branches of the autonomic network as well as their interaction in schizophrenia.
