title: Cardiovagal and adrenergic function tests in unilateral carotid artery stenosis patients-a Valsalva manoeuvre tool to show an autonomic dysfunction?
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Neurology, Department of Vascular Neurology and Neurological Intensive Care, Neurological Intensive Care Unit, 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 2, 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
authors.affiliation: 2nd Department of Internal Medicine, Faculty of Medicine, Comenius University and University Hospital, Mickiewiczova 13, 813 69, Bratislava, Slovak Republic.
authors.forename: Ludovit
authors.initials: L
authors.lastname: Gaspar
authors.affiliation: Institute of Histology and Embryology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Petrovič
authors.affiliation: 2nd Department of Internal Medicine, Faculty of Medicine, Masaryk University, Pekarska 53, 656 91, Brno, Czech Republic.|Laboratory of Structural Biology and Proteomics, Faculty of Pharmacy, University of Veterinary Medicine and Pharmaceutical Sciences, Brno, Czech Republic.
authors.forename: Peter
authors.initials: P
authors.lastname: Kruzliak
mesh_terms: D018663:Adrenergic Agents / Q000008:administration & dosage*; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D017704:Baroreflex; D001794:Blood Pressure; D002346:Carotid Sinus / Q000187:drug effects / Q000503:physiopathology; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014636:Valsalva Maneuver
chemical_list: D018663:Adrenergic Agents
keywords: Autonomic nervous system disorders; Baroreflex; Carotid artery stenosis; Carotid sinus; Valsalva manoeuvre