Causal relationships between heart period and systolic arterial pressure during graded head-up tilt

Author(s)

Porta, Alberto ^[1] ; Catai, Aparecida M. ^[2] ; Takahashi, Anielle C. M. ^[2] ; Magagnin, Valentina ; Bassani, Tito ^[3] ; Tobaldini, Eleonora ^[4] ; van de Borne, Philippe ^[5] ; Montano, Nicola ^[4]

Affiliation

^[1] Univ Milan, Dipartimento Tecnol Salute, Ist Ortoped Galeazzi, Lab Modellist Sistemi Complessi, I-20161 Milan - Italy

^[2] Univ Fed Sao Carlos, Dept Physiotherapy, BR-13560 Sao Carlos, SP - Brazil

^[3] Polytech Univ Milan, Dept Bioengn, Milan - Italy

^[4] Univ Milan, Dept Clin Sci, L Sacco Hosp, I-20161 Milan - Italy

^[5] Free Univ Brussels, Erasme Hosp, Hypertens Clin, Dept Cardiol, B-1050 Brussels - Belgium

• Document type: Journal article
• Source: AMERICAN JOURNAL OF PHYSIOLOGY-REGULATORY INTEGRATIVE AND COMPARATIVE PHYSIOLOGY; v. 300, n. 2, p. R378-R386, FEB 2011.
• Web of Science Citations: 80

Abstract

Porta A, Catai AM, Takahashi AC, Magagnin V, Bassani T, Tobaldini E, van de Borne P, Montano N. Causal relationships between heart period and systolic arterial pressure during graded head-up tilt. Am J Physiol Regul Integr Comp Physiol 300: R378-R386, 2011. First published October 20, 2010; doi: 10.1152/ajpregu.00553.2010.-In physiological conditions, heart period (HP) affects systolic arterial pressure (SAP) through diastolic runoff and Starling's law, but, the reverse relation also holds as a result of the continuous action of baroreflex control. The prevailing mechanism sets the dominant temporal direction in the HP-SAP interactions (i.e., causality). We exploited cross-conditional entropy to assess HP-SAP causality. A traditional approach based on phases was applied for comparison. The ability of the approach to detect the lack of causal link from SAP to HP was assessed on 8 short-term (STHT) and 11 long-term heart transplant (LTHT) recipients (i.e., less than and more than 2 yr after transplantation, respectively). In addition, spontaneous HP and SAP variabilities were extracted from 17 healthy humans (ages 21-36 yr, median age 29 yr; 9 females) at rest and during graded head-up tilt. The tilt table inclinations ranged from 15 to 75 and were changed in steps of 15. All subjects underwent recordings at every step in random order. The approach detected the lack of causal relation from SAP to HP in STHT recipients and the gradual restoration of the causal link from SAP to HP with time after transplantation in the LTHT recipients. The head-up tilt protocol induced the progressive shift from the prevalent causal direction from HP to SAP to the reverse causality (i.e., from SAP to HP) with tilt table inclination in healthy subjects. Transformation of phases into time shifts and comparison with baroreflex latency supported this conclusion. The proposed approach is highly efficient because it does not require the knowledge of baroreflex latency. The dependence of causality on tilt table inclination suggests that ``spontaneous{''} baroreflex sensitivity estimated using noncausal methods (e.g., spectral and cross-spectral approaches) is more reliable at the highest tilt table inclinations. (AU)