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Postextrasystolic regulation patterns of blood pressure and heart rate in patients with idiopathic dilated cardiomyopathy
Author(s) -
Voss Andreas,
Baier Vico,
Schumann Agnes,
Hasart Annette,
Reinsperger Franziska,
Schirdewan Alexander,
Osterziel KarlJosef,
Leder Uwe
Publication year - 2002
Publication title -
the journal of physiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.802
H-Index - 240
eISSN - 1469-7793
pISSN - 0022-3751
DOI - 10.1113/jphysiol.2001.013044
Subject(s) - cardiology , medicine , baroreflex , heart rate , dilated cardiomyopathy , blood pressure , heart rate turbulence , heart failure , heart rate variability
Assessment of fluctuations in heart rate (HR) following a premature ventricular complex (PVC) is valuable for identifying patients at high risk of sudden cardiac death. We hypothesised that postextrasystolic potentiation is the main determinant of the regulation patterns of blood pressure (BP) and HR following a PVC. Twelve patients with idiopathic dilated cardiomyopathy (IDC) and 13 control subjects with single PVCs (comparable coupling intervals) were investigated. Non‐invasive finger arterial BP and ECGs were analysed. Regulation patterns following a single PVC were quantified using the indices postextrasystolic amplitude potentiation (PEAP) and maximum turbulence slope of five consecutive mean BP values (MBP‐TS), and compared with the HR turbulence parameters turbulence slope (HR‐TS) and turbulence onset (HR‐TO). PEAP was significantly higher in IDC patients compared to controls (48.7 ± 32.6 vs . 9.8 ± 5.4 %, P < 0.01), whereas MBP‐TS was lower (0.97 ± 0.60 vs . 2.07 ± 1.04 mmHg BBI −1 (BBI, beat‐to‐beat interval), P < 0.05), as was HR‐TS (8.46 ± 7.90 vs . 30.73 ± 22.90 ms BBI −1 , P < 0.01). HR‐TO was significantly higher in IDC patients (−0.56 ± 2.19 vs .−5.52 ± 4.13 %, P < 0.01). In addition, the regulation patterns of BP and HR following a single PVC differed significantly between IDC patients and controls. Specifically, we observed pronounced PEAPs in IDC patients. The baroreflex response initiated by the low pressure amplitude of the PVC was suppressed in IDC patients due to the augmented potentiation of the first postextrasystolic blood pressure. Furthermore, IDC patients displayed impressive postextrasystolic pulsus alternans phenomena, whereas healthy subjects exhibited a typical baroreflex pattern. The pulsus alternans phenomenon seems to be triggered by a PVC.