title: Simple cardiovagal and adrenergic function tests in carotid artery stenosis patients as a potential tool for determining a transient autonomic dysfunction.
abstract: OBJECTIVE
  The arterial baroreflex depends on the integrity of the afferent limb, which can be quantified using the baroreceptor's sensitivity (BRS) during the Valsalva maneuver (VM). The aim of this study was to evaluate, using autonomic nervous system tests, the autonomic function in patients after a carotid artery angioplasty (CAS).
  
  
  METHODS
  We evaluated the changes in blood pressure (BP) during the VM (Valsalva ratio, BRS, sympathetic indexes) in 41 patients with symptomatic, unilateral, internal carotid artery stenosis.
  
  
  RESULTS
  The Valsalva ratio between the baseline and the post-procedural day (1.3 ± 0.1 vs 1.44 ± 0.3; P = 0.002) and the post-procedural day and a month later (1.44 ± 0.3 vs 1.3 ± 0.3; P = 0.0002) revealed significant differences. This was confirmed with a cardiovagal BRS test. However, the adrenergic BRS did not reveal any differences. Sympathetic indexes [BP fall (SI1) and recovery during phase 2 (SI2)] showed differences for the periods before and a day after the treatment (36.9 ± 18.0 vs 27.2 ± 21.4 and 7.1 ± 13.1 vs 3.0 ± 8.2, respectively; P = 0.004) and for SI1 a day and a month after the treatment (27.2 ± 21.4 vs 37.1 ± 21.8; P = 0.036). The dynamic ranges between S1 and S3 (the difference in the BP between the baseline and the end of phase 2) were also different (P = 0.007 and P = 0.044, respectively).
  
  
  CONCLUSIONS
  We found heterogeneous responses in the BP regulation obtained with the Valsalva maneuver in our patients; however, we could not confirm that CAS provoked any long-term autonomic dysfunction, except for 1 day after the procedure.
authors.affiliation: Neurological Intensive Care Unit, Division of Neurology, Department of Vascular Neurology and Intensive Care, University Medical Centre Ljubljana, Zaloška 2, 1525, Ljubljana, Slovenia. viktor.svigelj@kclj.si.
authors.forename: Viktor
authors.initials: V
authors.lastname: Švigelj
authors.affiliation: Division of Internal Medicine, Department of Cardiology, University Medical Centre Ljubljana, Zaloška 7, 1525, Ljubljana, Slovenia.
authors.forename: Matjaž
authors.initials: M
authors.lastname: Šinkovec
authors.affiliation: Department of Communication Systems, Jožef Stefan Institute, Jamova 39, 1000, Ljubljana, Slovenia.
authors.forename: Viktor
authors.initials: V
authors.lastname: Avbelj
authors.affiliation: Department of Communication Systems, Jožef Stefan Institute, Jamova 39, 1000, Ljubljana, Slovenia.
authors.forename: Roman
authors.initials: R
authors.lastname: Trobec
mesh_terms: D018663:Adrenergic Agents / Q000494:pharmacology*; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D017704:Baroreflex / Q000187:drug effects / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014636:Valsalva Maneuver / Q000502:physiology*
chemical_list: D018663:Adrenergic Agents
keywords: Angioplasty; Autonomic dysreflexia; Baroreflex; Carotid stenosis; Valsalva maneuver