St Annes University Hospital In Brno Fnusa

Brno, Czech Republic

St Annes University Hospital In Brno Fnusa

Brno, Czech Republic
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Wszedybyl-Winklewska M.,Medical University of Gdańsk | Wolf J.,Medical University of Gdańsk | Wolf J.,St Annes University Hospital In Brno Fnusa | Swierblewska E.,Medical University of Gdańsk | And 9 more authors.
PLoS ONE | Year: 2017

Background and objective: Respiration is known to affect cerebrospinal fluid (CSF) movement. We hypothesised that increased inspiratory resistance would affect the dynamic relationship between blood pressure (BP) changes and subarachnoid space width (SAS) oscillations. Methods: Experiments were performed in a group of 20 healthy volunteers undergoing controlled intermittent Mueller Manoeuvres (the key characteristic of the procedure is that a studied person is subjected to a controlled, increased inspiratory resistance which results in marked potentiation of the intrathoracic negative pressure). BP and heart rate (HR) were measured using continuous finger-pulse photoplethysmography; oxyhaemoglobin saturation with an ear-clip sensor; end-tidal CO2 with a gas analyser; cerebral blood flow velocity (CBFV), pulsatility and resistive indices with Doppler ultrasound. Changes in SAS were recorded with a new method i.e. near-infrared transillumination/backscattering sounding. Wavelet transform analysis was used to assess the BP and SAS oscillations coupling. Results: Initiating Mueller manoeuvres evoked cardiac SAS component decline (-17.8%, P<0.001), systolic BP, diastolic BP and HR increase (+6.3%, P<0.001; 6.7%, P<0.001 and +2.3%, P<0.05, respectively). By the end of Mueller manoeuvres, cardiac SAS component and HR did not change (+2.3% and 0.0%, respectively; both not statistically significant), but systolic and diastolic BP was elevated (+12.6% and +8.9%, respectively; both P<0.001). With reference to baseline values there was an evident decrease in wavelet coherence between BP and SAS oscillations at cardiac frequency in the first half of the Mueller manoeuvres (-32.3%, P<0.05 for left hemisphere and -46.0%, P<0.01 for right hemisphere) which was followed by subsequent normalization at end of the procedure (+3.1% for left hemisphere and +23.1% for right hemisphere; both not statistically significant). Conclusions: Increased inspiratory resistance is associated with swings in the cardiac contribution to the dynamic relationship between BP and SAS oscillations. Impaired cardiac performance reported in Mueller manoeuvres may influence the pattern of cerebrospinal fluid pulsatility. © 2017 Wszedybyl-Winklewska et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Wolf J.,Medical University of Gdańsk | Wolf J.,St Annes University Hospital In Brno Fnusa | Swierblewska E.,Medical University of Gdańsk | Jasiel-Wojculewicz H.,Medical University of Gdańsk | And 4 more authors.
Chest | Year: 2014

We report a case of a 41-year-old man who was noted to have position-dependent Cheyne-Stokes respiration with central sleep apnea (CSA) during sleep. The patient had multiple cardiovascular risk factors and target organ damages, including a history of two myocardial infarctions, transient ischemic attack, and chronic kidney disease. His hypertension was refractory to a number of antihypertensive medicines, however, a complete elimination of sleep-disordered breathing with oral theophylline treatment was paralleled by a signifi cant BP fall with a subsequent need for reduction of antihypertensive drugs. Following these surprising observations we decided to withdraw theophylline from treatment (in-clinic). Theophylline discontinuation resulted in a gradual increase in BP and an urgent call for antihypertensive treatment modifi cation. These observations suggest a potent hypotensive action of oral theophylline via Cheyne- Stokes respiration with CSA elimination. Our data suggest that CSA may be a mechanism that raises BP even during the daytime. © 2014 AMERICAN COLLEGE OF CHEST PHYSICIANS.


Wszedybyl-Winklewska M.,Medical University of Gdańsk | Wolf J.,Medical University of Gdańsk | Wolf J.,St Annes University Hospital In Brno Fnusa | Swierblewska E.,Medical University of Gdańsk | And 8 more authors.
Journal of Hypertension | Year: 2015

Background: Little is known about intracranial pressure (ICP)-cerebral haemodynamic interplay during repetitive apnoea. A recently developed method based on nearinfrared transillumination/backscattering sounding (NIR-T/ BSS) noninvasively measures changes in pial artery pulsation (cc-TQ) as well as subarachnoid width (sas-TQ) in humans. Method: We tested the complex response of the pial artery and subarachnoid width to apnoea using this method. The pial artery and subarachnoid width response to consecutive apnoeas lasting 30, 60 s and maximal breathhold (91.1±23.1 s) were studied in 20 healthy volunteers. The cc-TQ and sas-TQ were measured using NIR-T/BSS; cerebral blood flow velocity (CBFV), pulsatility index and resistive index were measured using Doppler ultrasound of the left internal carotid artery; heart rate (HR) and beat-tobeat SBP and DBP blood pressure were recorded using a Finometer; end-tidal CO2 (EtCO2) was measured using a medical gas analyser. Results: Apnoea evoked a multiphasic response in blood pressure, pial artery compliance and ICP. First, SBP declined, which was accompanied by an increase in cc-TQ and sas-TQ. Directly after these changes, SBP exceeded baseline values, which was followed by a decline in cc-TQ and the return of sas-TQ to baseline. During these initial changes, CBFV remained stable. Towards the end of the apnoea, BP, cc-TQ and CBFV increased, whereas pulsatility index, resistive index and sas-TQ declined. Changes in sas-TQ were linked to changes in EtCO2, HR and SBP. Conclusion: Apnoea is associated with ICP swings, closely reflecting changes in EtCO2, HR and peripheral BP. The baroreflex influences the pial artery response. © 2015 Wolters Kluwer Health, Inc. All rights.


Winklewski P.J.,Medical University of Gdańsk | Gruszecki M.,Medical University of Gdańsk | Wolf J.,Medical University of Gdańsk | Wolf J.,St Annes University Hospital In Brno Fnusa | And 9 more authors.
Microvascular Research | Year: 2015

Pial artery adjustments to changes in blood pressure (BP) may last only seconds in humans. Using a novel method called near-infrared transillumination backscattering sounding (NIR-T/BSS) that allows for the non-invasive measurement of pial artery pulsation (cc-TQ) in humans, we aimed to assess the relationship between spontaneous oscillations in BP and cc-TQ at frequencies between 0.5. Hz and 5. Hz. We hypothesized that analysis of very short data segments would enable the estimation of changes in the cardiac contribution to the BP vs. cc-TQ relationship during very rapid pial artery adjustments to external stimuli.BP and pial artery oscillations during baseline (70s and 10s signals) and the response to maximal breath-hold apnea were studied in eighteen healthy subjects. The cc-TQ was measured using NIR-T/BSS; cerebral blood flow velocity, the pulsatility index and the resistive index were measured using Doppler ultrasound of the left internal carotid artery; heart rate and beat-to-beat systolic and diastolic blood pressure were recorded using a Finometer; end-tidal CO2 was measured using a medical gas analyzer. Wavelet transform analysis was used to assess the relationship between BP and cc-TQ oscillations.The recordings lasting 10. s and representing 10. cycles with a frequency of ~. 1. Hz provided sufficient accuracy with respect to wavelet coherence and wavelet phase coherence values and yielded similar results to those obtained from approximately 70. cycles (70. s). A slight but significant decrease in wavelet coherence between augmented BP and cc-TQ oscillations was observed by the end of apnea.Wavelet transform analysis can be used to assess the relationship between BP and cc-TQ oscillations at cardiac frequency using signals intervals as short as 10. s. Apnea slightly decreases the contribution of cardiac activity to BP and cc-TQ oscillations. © 2015 Elsevier Inc..


Wolf J.,Medical University of Gdańsk | Wolf J.,St Annes University Hospital In Brno Fnusa | Drozdowski J.,Medical University of Gdańsk | Czechowicz K.,Medical University of Gdańsk | And 7 more authors.
International Journal of Cardiology | Year: 2016

Background: Beta1-receptor antagonists (BBs) are commonly administered in the treatment of cardiovascular disease (CVD). The reported benefits of BB use in CVD patients with concomitant obstructive sleep apnea (OSA) may be limited by their impact on apnea-induced bradycardias. Therefore the aim of the study was to test the influence of BBs on periapneic heart rate (HR) fluctuations in hypertensive patients with newly-detected and untreated OSA. Methods: We studied 88 hypertensive patients (56 on BBs and 32 BB naive) with newly-diagnosed moderate-to-severe OSA who were free of major pulmonary comorbidities and did not require antiarrhythmic therapy. ECGs recorded during sleep were investigated for heart rate (HR) responses to apneas allowing to compare extreme HR accelerations and decelerations between the groups. Results: Average sleep-time HR was comparable in BB-naive (BB -) and BB-treated (BB +) patients. Direct comparisons showed that HR decelerations were also similar in the two subgroups (53.8 ± 9.6 vs. 54.4 ± 7.8 bpm; P = 0.78, for BB - and BB +, respectively) however, BBs blunted the OSA-induced HR accelerations (82.3 ± 12.2 vs. 74.3 ± 10.0; P = 0.003). After adjusting for baseline HR and magnitude of desaturations, HR decelerations were more evident in BB-naive group whereas tachycardic responses remained blunted in the BB + group. The incidence of ectopies and conduction abnormalities were comparable across two groups. Conclusions: Beta-blockers do not potentiate apnea-induced HR decelerations, attenuate apnea-induced increases in heart rate and do not influence incidence of ectopies and conduction abnormalities in patients with hypertension and moderate-to-severe, untreated OSA. © 2015 Elsevier Ireland Ltd. All rights reserved.


Hoffmann M.,Medical University of Gdańsk | Polonis K.,Medical University of Gdańsk | Szyndler A.,Medical University of Gdańsk | wierblewska E.,Medical University of Gdańsk | And 8 more authors.
Nadcisnienie Tetnicze | Year: 2015

Background: Publication of the JUPITER trial has renewed the interest in the use of CRP in cardiovascular risk prediction. The aim of the study was to assess the relationship between CRP, ambulatory blood pressure and target organ damage in a cohort of treated hypertensive males without overt cardiovascular disease. Materials and methods: The studied group consisted of 299 male hypertensive patients. Patients were stratified into low (≤ 2 mg/L), intermediate (2-5 mg/L), and high (> 5 mg/L) CRP groups. We measured ambulatory blood pressure, pulse wave velocity, left ventricular function and structure, carotid intima media thickness and ankle-brachial index. Results: Twenty-six percent of the patients had CRP in the range of 2 to 5 mg/L, and 12% had CRP levels exceeding 5 mg/L. Ambulatory blood pressure and heart rate were not different across the three groups. Patients with high CRP had lower HDL cholesterol levels and higher plasma fibrinogen levels. Carotid femoral pulse wave velocity, carotid intima media thickness and ankle-brachial index were not different across the three groups. Echocardiographic data were also not related to the CRP level. Conclusions: 1. Elevated levels of CRP are frequently observed among treated patients with hypertension. 2. CRP elevation is associated with higher fibrinogen and glucose levels, and lower HDL cholesterol independently of obesity and smoking status. 3. Elevated CRP levels are not related to ambulatory blood pressure profile or target organ damage severity. 4. Our findings are consistent with the concept that CRP measurement is of limited value in cardiovascular assessment. Copyright © 2015 Via Medica.

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