P321 Differences in adrenergic components of baroreflex response to Valsalva maneuver in different phenotypes of multiple sclerosis

Autor: Ivan Adamec, Mario Habek, Tereza Gabelić, Biljana Dapic, Bojana Nevajdic, Luka Crnošija, Magdalena Krbot Skorić, Tomislav Mutak, Dunja Pucic
Rok vydání: 2017
Předmět:
Zdroj: Clinical Neurophysiology. 128:e282
ISSN: 1388-2457
Popis: Objectives To evaluate differences in recently developed, non-standard adrenergic baroreflex sensitivity (BRS) indices between patients with clinically isolated syndrome (CIS), relapsing remitting multiple sclerosis (RRMS) and progressive forms of multiple sclerosis (PMS). Methods This retrospective analysis included 153 patients with MS (78 CIS, 57 RRMS and 18 PMS patients). Systolic blood pressure (sBP) responses during Valsalva maneuver (VM) were divided into three subtypes: balanced – subtype 1 (a sBP dip below baseline in late phase II (IIL) and recovery in phase IV), suppressed – subtype 2 (a non-dipping BP) and augmented – subtype 3 (a BP recovery in phase IIL) autonomic response. Alternative adrenergic component of BRS (BRSa1), and alpha- ( α -BRSa) and beta-adrenergic ( β -BRSa) components of adrenergic BRS were calculated and compared between the groups. Furthermore, in all patients, adrenergic index (part of the composite autonomic scoring scale (CASS)) was available. Results There was no difference in the subtypes of sBP responses during VM, BRSa1, α -BRSa and β -BRSa between groups. In patients with subtype 1 of sBP responses during VM, there was a significant difference in BRSa1 and β -BRSa between groups ( p = 0.049 and p = 0.039, respectively). When dividing the patients depending on sympathetic dysfunction (sympathetic dysfunction defined as adrenergic index ⩾ 1), patients with subtype 1 response and sympathetic dysfunction had significantly lower BRSa1 compared to patients with subtype 1 response and no sympathetic dysfunction (19.75 ± 13.90 vs 30.63 ± 20.52, p Discussion It has been suggested that new BRSa measurements may help differentiate normal physiologic variants from mild dysautonomia. Conclusion Differences in non-standard adrenergic BRS indices can be observed in different MS phenotypes depending on the subtype of sBP responses during VM. They are present in patients with subtype 1 of the autonomic response. Significance Low BRSa1 may indicate more pronounced sympathetic dysfunction in MS patients.
Databáze: OpenAIRE
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