Simone Cencetti

Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms: comparative study

Abstract Objective: To test whether rhythmic formulas such as the rosary and yoga mantras can synchronise and reinforce inherent cardiovascular rhythms and modify baroreflex sensitivity. Design: Comparison of effects of recitation of the Ave Maria (in Latin) or of a mantra, during spontaneous and metronome controlled breathing, on breathing rate and on spontaneous oscillations in RR interval, and on blood pressure and cerebral circulation. Setting: Florence and Pavia, Italy. Participants: 23 healthy adults. Main outcome measures: Breathing rate, regularity of breathing, baroreflex sensitivity, frequency of cardiovascular oscillations. Results: Both prayer and mantra caused striking, powerful, and synchronous increases in existing cardiovascular rhythms when recited six times a minute. Baroreflex sensitivity also increased significantly, from 9.5 (SD 4.6) to 11.5 (4.9) ms/mm Hg, P<0.05. Conclusion: Rhythm formulas that involve breathing at six breaths per minute induce favourable psychological and possibly physiological effects. What is already known on this topic Reduced heart rate variability and baroreflex sensitivity are powerful and independent predictors of poor prognosis in heart disease Slow breathing enhances heart rate variability and baroreflex sensitivity by synchronising inherent cardiovascular rhythms What this study adds Recitation of the rosary, and also of yoga mantras, slowed respiration to almost exactly 6/min, and enhanced heart rate variability and baroreflex sensitivity The rosary might be viewed as a health practice as well as a religious practice

Effect of Pco2 Changes Induced by Head-Upright Tilt on Transcranial Doppler Recordings

BACKGROUND AND PURPOSE Transcranial Doppler (TCD) monitoring of mean blood flow velocity (mV) during head-upright tilt can allow testing of cerebral autoregulation. Nonetheless, head-upright tilt can induce changes in the ventilation-perfusion relationship and/or respiratory activity that might influence TCD data. METHODS Forty-eight healthy volunteers underwent monitoring of mV and end-tidal CO2 in the horizontal position and during head-upright tilt. RESULTS Both mV and end-tidal CO2 significantly decreased in orthostasis (P < .01). Linear regression analysis showed a significant linkage between end-tidal CO2 and mV changes (r = .83, P < .01). CONCLUSIONS Changes in ventilation-perfusion ratio and in the respiratory pattern induced by head-upright tilt can significantly influence TCD data by determining a PCO2 decrease.

Cerebral autoregulation in orthostatic hypotension. A transcranial Doppler study.

Transcranial Doppler measurements of blood flow velocity permit an assessment of variations in intracraniaJ hemodynamics in response to acute arterial pressure variations. The purpose of this study was to scan healthy volunteers and patients with autonomic failure for differences in cerebral hemodynamic patterns under an acute hypotensive stimulus. Methods We used transcranial Doppler monitoring of blood flow velocity in the middle cerebral artery and noninvasive monitoring of arterial blood pressure and heart rate before, during, and after acute arterial hypotension induced by reactive hyperemia of the lower limbs. Results After maximum hypotension, the mean blood flow velocity was higher in the healthy volunteers than in the patients. In the healthy subjects mean velocity rose significantly (P<.01) higher than arterial blood pressure after 30 seconds and 60 seconds; in the patients mean velocity and arterial pressure moved in parallel fashion. The diastolic blood flow velocity increased more in the control group than in the patients during the early stages of the test; furthermore, only in the healthy volunteers did it increase significantly more than arterial pressure after 30 seconds and 60 seconds. Regarding the pulsatility index, the differences between the two groups were similar to the diastolic velocity results. Conclusions (1) Monitoring of mean blood flow velocity showed the ability to mantain an adequate cerebral blood flow in healthy subjects; this mechanism was not efficient in the patients with autonomic failure. (2) Diastolic velocity and pulsatility index values clearly showed that only in healthy subjects were cerebral hemodynamics relatively independent of pressure values.

Cerebral autoregulation in patients with cirrhosis and ascites: A transcranial Doppler study

BACKGROUND/AIMS Patients with cirrhosis and ascites usually show alterations of systemic hemodynamics and are thus prone to develop arterial hypotension, which might result in cerebral hypoperfusion if cerebral autoregulation is impaired. METHODS We evaluated cerebral autoregulation in 15 patients with cirrhosis and ascites and 15 healthy subjects by monitoring mean blood flow velocity in the middle cerebral artery and arterial pressure during supine rest and passive tilting. RESULTS Tilt provoked a drop of arterial pressure in both groups. Control subjects had a prompt recovery of mean flow velocity and a progressive recovery of arterial pressure, so that, after 120 s, both parameters had returned to baseline: at 20 s the recovery of flow velocity was faster (p<0.01) than that of blood pressure. By contrast, patients with cirrhosis had a delayed and incomplete recovery of both parameters (p<0.01 vs healthy subjects). In eight patients, the recovery of mean flow velocity paralleled that of arterial pressure, indicating an impaired cerebral autoregulation. These patients had a worse liver function, a higher cardiac index and lower peripheral resistance. CONCLUSIONS Cerebral autoregulation is often impaired in patients with cirrhosis and ascites. These patients can develop cerebral hypoperfusion if arterial pressure falls abruptly.

Compliance with therapy in hypertensive patients

ObjectiveThis study investigated pharmacological compliance in hypertensive patients recruited during a 24-month period at the Hypertension Clinic of the S. Maria Nuova Hospital.MethodsThe compliance profile scale was developed in order to classify complicance as sufficient, or poor. Compliance was evaluated according to patients’ 1) global cardiovascular risk (hypertensive) and 2) complexity of prescribed treatment at enrolment (drug, number of pills).ResultsA total of 367 patients were recruited; 82 were excluded owing to changes in therapeutic schedule or medication necessitated by other medical or surgical disease. Compliance was evaluated in 285 patients, 66% were male; the mean age was 72±12 years. Compliance was evaluated at a series of follow-ups at 3-month intervals and at 36 months of observation. Compliance at 36 months was good or sufficient in 56% of patients, but differed according to hypertensive and drug status. Compliance was better in patients with a higher level vs lower level of hypertension severity. Specifically, compliance was better in hypertensives with co-morbidity (76%) than in hypertensives without co-morbidity (37%) or hypertensives with risk factors (65%). Moreover, compliance was better in patients with a more complex therapeutic regimen (drug 1 through 3: 47, 59 and 66%).ConclusionsThese data demonstrate a relationship between disease severity and compliance, independent of the prescribed therapeutic regimen. This suggests that the most important factor for therapy adherence is disease awareness and severity, and patients with a higher level of disease are more likely to be compliant.

Age-related changes of cardiac parasympathetic modulation after vasovagal syncope

The time-domain analysis of 24-hour electrocardiographic recordings showed that vagal modulation of heart rate is reduced within 48 hours from vasovagal syncope. However, patients with recent vasovagal syncope can be differentiated from healthy subjects only up to the age of 40 years with this analysis, because this parasympathetic modulation physiologically decreases with increasing age.

Postural Hypotension in Hypertensive Patients

Background: The association between orthostatic hypotension and supine hypertension (Hypo–Hyper) has been reported in previous studies on selected populations. The present longitudinal study aimed to characterize the haemodynamic patterns, comorbidity, prognostic implications and eventual effect of therapy in patients with the Hypo–Hyper pattern. Methods: Ambulatory blood pressure monitoring (AMAP) and clinical evaluation were performed on 615 consecutive patients recruited from the Hypertension Clinics of five Italian Hospitals: 34 patents were identified as Hypo–Hyper, and underwent 10‐month follow‐up. Results: The incidence of the Hypo–Hyper pattern was 5.5% in the hypertensives studied. Hypo–Hyper was more frequent in the elderly (mean age 58 years), and the affected population exhibited different kinds of underlying pathologies. Multivariate analysis showed no association between antihypertensive treatment and Hypo–Hyper pattern. Patients with AMAP features of higher blood pressure values at night‐time than at daytime displayed higher rates of myocardial hypertrophy and pacemaker implantation during the follow‐up. Conclusions: Although the study design did not aim to identify any pathophysiological mechanism for Hypo–Hyper pattern, these first data show that the Hypo–Hyper association is the effect of a particular subtype of hypertension, with significantly different prognostic implications.

Plasma volume and hematocrit changes in recurrent fainters.

Abstract.The pooling of blood in the limbs is the beginning of a chain of events which brings about the reflex syncope. Observations have confirmed that the reduction of plasma volume is also a factor pathogenetically determinant in the provocation of a faint. During orthostatic stress, plasma volume shifts towards the interstitial spaces of the infra-diaphragmatic vascular network, thus, contributing greatly to the reduction in the circulating volume. The aim of the present study was to calculate whether during orthostasis there was indeed a reduction in plasma volume and to what extent in a population at high risk for fainting. A comparative study of 50 recurrent fainters and 37 controls was performed. Each group was studied both in a supine (before) and orthostatic (after) position. Blood samples were taken to determine the hematocrit and hemoglobin values. The percentage variation of these values was calculated in order to obtain the reduction in plasma volume, i. e., the expression of the amount of plasma accumulated in the interstitial spaces. A significant difference in hematocrit and hemoglobin variation (before vs. after) was found between patients and controls. Plasma volume variation before vs. after (17.1 % in patients vs. 8.6 % in controls) was then calculated using these measurements. The difference in plasma volume variation between patients and controls can be interpreted as a co-factor together with the pooling of plasma in the pathogenesis of reflex fainting. This study illustrates an easy way to evaluate the role of plasma volume reduction in the pathogenesis of vasovagal syncope.

Autonomic control of heart rate variability in vasovagal syncope: a study of the nighttime period in 24-hour recordings.

Patients experiencing vasovagal syncope have been claimed to show reduced vagal tone over 24-hour electrocardiography recordings. Assessment of sympathovagal balance in the absence of external stimuli,ie, nighttime electrocardiography monitoring, might help to clarify if increased sympathetic activity is present in these patients. Heart rate variability was examined at nighttime in 40 patients with recurrent episodes of vasovagal syncope within the last 2 years (22 men; mean age, 37 years) and 20 comparable healthy volunteers. Time domain parameters (pNN50 [proportion of successive RR intervals difference > 50 ms in %] and rMSSD [root-mean-square successive difference of RR intervals in ms]), indexes of vagal tone, and frequency domain parameters, expressing the overall heart rate variability, vagal (high frequency [HF]) and sympathetic (low frequency [LF]) activity, and autonomic balance (LF/HF ratio) were compared between groups by Mann-Whitney test. Significant (p<0.05) reduction of heart rate variability and vagal tone (pNN50 and rMSSD) were found for patients with vasovagal syncope, together with increased sympathetic activity (increased LF/HF ratio). These findings could open new insights in the pathogenesis of vasovagal syncope because of the shift of the autonomic balance toward sympathetic activation near the syncopal episode.

Outcome of patients with elevated cardiac troponin I level after mild trauma.

The objective of this study was to evaluate whether increased c-Tnl in patients suffering from mild trauma without cardiac disease may be prognostic for future cardiac events. Consecutive patients suffering from mild trauma were recruited and evaluated for levels of creatinine, creatine-kinase (CK) and c-Tnl. Patients with elevated c-Tnl were selected and followed up for six months for cardiac events (cardiac death, Myocardial Infarction, Acute Coronary Syndromes, cardiac syncope, pacemaker or Intracardiac Device Implantation, Percutaneous Cardiac Intervention, and aortic-coronary bypass). No relationship was found between levels of c-Tnl and CK or creatinine. Patients with elevated c-Tnl suffered significantly more of cardiac events than did patients with normal levels of c-Tnl. Increased of c-Tnl in patients experiencing mild trauma but not cardiac diseases may be a preclinic index of future cardiac disease.