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01.07.2016 | original article | Ausgabe 13-14/2016

Wiener klinische Wochenschrift 13-14/2016

Cardiovagal and adrenergic function tests in unilateral carotid artery stenosis patients—a Valsalva manoeuvre tool to show an autonomic dysfunction?

Zeitschrift:
Wiener klinische Wochenschrift > Ausgabe 13-14/2016
Autoren:
Dr. Viktor Švigelj, Dr. Matjaž Šinkovec, Dr. Viktor Avbelj, Dr. Roman Trobec, Dr. Ludovit Gaspar, Dr. Daniel Petrovič, Dr. Peter Kruzliak

Summary

Background

The stability of an arterial baroreflex depends also upon the integrity of the afferent limb. For its quantification, we can use a noninvasive test such as baroreceptor sensitivity estimation during Valsalva manoeuvre. The aim of this study was to evaluate potential autonomic dysfunction in patients with unilateral severe carotid disease and compare the results to the results obtained from an age and gender matched group of healthy volunteers.

Methods

We evaluated dynamic changes during Valsalva manoeuvre (Valsalva ratio, cardiovagal and adrenergic baroreceptor sensitivity, sympathetic indexes and its dynamic ranges) in 41 patients (29 males; 62.9 ± 7.4 years) and compared the results to results obtained from volunteers (62.8 ± 7.0 years).

Results

Valsalva ratio between the patients and control group revealed no significant difference, as well as cardiovagal and adrenergic baroreceptor sensitivity. Sympathetic indexes, except for sympathetic index 2, reflecting the sympathetic vasoconstrictor baroreceptor response in late phase 2 of Valsalva manoeuvre (7.1 ± 13.1 mmHg in patients vs. 11.4 ± 10.2 mmHg in control group; p = 0.012) showed no significant differences between the studied groups. The most prominent dynamic range between the groups was within the sympathetic index 2.

Conclusion

With some Valsalva manoeuvre test results, we were not able to show severe autonomic dysfunction in unilateral severe carotid stenosis patients except for lower vasoconstriction response within the late phase 2 of the manoeuvre.

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