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At least 379 records · Page 21

Hypocapnia and cerebral hypoperfusion in orthostatic intolerance

BACKGROUND AND PURPOSE: Orthostatic and other stresses trigger tachycardia associated with symptoms of tremulousness, shortness of breath, dizziness, blurred vision, and, often, syncope. It has been suggested that paradoxical cerebral vasoconstriction during head-up tilt might be present in patients with orthostatic intolerance. We chose to study middle cerebral artery (MCA) blood flow velocity (BFV) and cerebral vasoregulation during tilt in patients with orthostatic intolerance (OI). METHODS: Beat-to-beat BFV from the MCA, heart rate, CO2, blood pressure (BP), and respiration were measured in 30 patients with OI (25 women and 5 men; age range, 21 to 44 years; mean age, 31.3+/-1.2 years) and 17 control subjects (13 women and 4 men; age range, 20 to 41 years; mean age, 30+/-1.6 years); ages were not statistically different. These indices were monitored during supine rest and head-up tilt (HUT). We compared spontaneous breathing and hyperventilation and evaluated the effect of CO2 rebreathing in these 2 positions. RESULTS: The OI group had higher supine heart rates (P<0.001) and cardiac outputs (P<0.01) than the control group. In response to HUT, OI patients underwent a greater heart rate increment (P<0.001) and greater reductions in pulse pressure (P<0.01) and CO2 (P<0.001), but total systemic resistance failed to show an increment. Among the cerebrovascular indices, all BFVs (systolic, diastolic, and mean) decreased significantly more, and cerebrovascular resistance (CVR) was increased in OI patients (P<0.01) compared with control subjects. In both groups, hyperventilation induced mild tachycardia (P<0.001), a significant reduction of BFV, and a significant increase of CVR associated with a fall in CO2. Hyperventilation during HUT reproduced hypocapnia, BFV reduction, and tachycardia and worsened symptoms of OI; these symptoms and indices were improved within 2 minutes of CO2 rebreathing. The relationships between CO2 and BFV and heart rate were well described by linear regressions, and the slope was not different between control subjects and patients with OI. CONCLUSIONS: Cerebral vasoconstriction occurs in OI during orthostasis, which is primarily due to hyperventilation, causing significant hypocapnia. Hypocapnia and symptoms of orthostatic hypertension are reversible by CO2 rebreathing.

Non-NASA Center↗

Relation of blood volume and blood pressure in orthostatic intolerance

A complex but crucial relationship exists between blood volume and blood pressure in human subjects; it has been recognized that in essential hypertension, renovascular hypertension, and pheochromocytoma, the relationship between plasma volume and diastolic blood pressure is an inverse one. This phenomenon has not been studied in individuals with low normal and reduced blood pressures. Orthostatic intolerance is a commonly encountered abnormality in blood pressure regulation often associated with tachycardia in the standing position. Most of these patients have varying degrees of reduced blood volume. We tested the hypothesis that the relationship previously found between plasma volume and diastolic blood pressure in pressor states would also hold in orthostatic intolerance. We studied 16 patients with a history of symptomatic orthostatic intolerance associated with an elevation in plasma norepinephrine in the upright posture and hypovolemia in 9 patients and normovolemia in 7 patients. Our studies demonstrate an inverse relationship between plasma volume and diastolic blood pressure in patients with orthostatic intolerance. This finding also holds for the change in diastolic blood pressure in response to upright posture. In this relationship, patients with orthostatic intolerance with high plasma norepinephrine resemble those with essential hypertension, renovascular hypertension, and pheochromocytoma. We conclude that in a variety of conditions at both ends of the blood pressure spectrum, the seemingly paradoxical association of hypovolemia and diastolic blood pressure is preserved.

NASA Discipline Regulatory Physiology↗

Pulmonary function in space

The lung is exquisitely sensitive to gravity, and so it is of interest to know how its function is altered in the weightlessness of space. Studies on National Aeronautics and Space Administration (NASA) Spacelabs during the last 4 years have provided the first comprehensive data on the extensive changes in pulmonary function that occur in sustained microgravity. Measurements of pulmonary function were made on astronauts during space shuttle flights lasting 9 and 14 days and were compared with extensive ground-based measurements before and after the flights. Compared with preflight measurements, cardiac output increased by 18% during space flight, and stroke volume increased by 46%. Paradoxically, the increase in stroke volume occurred in the face of reductions in central venous pressure and circulating blood volume. Diffusing capacity increased by 28%, and the increase in the diffusing capacity of the alveolar membrane was unexpectedly large based on findings in normal gravity. The change in the alveolar membrane may reflect the effects of uniform filling of the pulmonary capillary bed. Distributions of blood flow and ventilation throughout the lung were more uniform in space, but some unevenness remained, indicating the importance of nongravitational factors. A surprising finding was that airway closing volume was approximately the same in microgravity and in normal gravity, emphasizing the importance of mechanical properties of the airways in determining whether they close. Residual volume was unexpectedly reduced by 18% in microgravity, possibly because of uniform alveolar expansion. The findings indicate that pulmonary function is greatly altered in microgravity, but none of the changes observed so far will apparently limit long-term space flight. In addition, the data help to clarify how gravity affects pulmonary function in the normal gravity environment on Earth.

short duration↗

Antarctic isolation: immune and viral studies

Stressful environmental conditions are a major determinant of immune reactivity. This effect is pronounced in Australian National Antarctic Research Expedition populations exposed to prolonged periods of isolation in the Antarctic. Alterations of T cell function, including depression of cutaneous delayed-type hypersensitivity responses and a peak 48.9% reduction of T cell proliferation to the mitogen phytohaemagglutinin, were documented during a 9-month period of isolation. T cell dysfunction was mediated by changes within the peripheral blood mononuclear cell compartment, including a paradoxical atypical monocytosis associated with altered production of inflammatory cytokines. There was a striking reduction in the production by peripheral blood mononuclear cells of the predominant pro-inflammatory monokine TNF-alpha and changes were also detected in the production of IL-1, IL-2, IL-6, IL-1ra and IL-10. Prolonged Antarctic isolation is also associated with altered latent herpesvirus homeostasis, including increased herpesvirus shedding and expansion of the polyclonal latent Epstein-Barr virus-infected B cell population. These findings have important long-term health implications.

NASA Discipline Environmental Health↗

Mechanical continuity and reversible chromosome disassembly within intact genomes removed from living cells

Chromatin is thought to be structurally discontinuous because it is packaged into morphologically distinct chromosomes that appear physically isolated from one another in metaphase preparations used for cytogenetic studies. However, analysis of chromosome positioning and movement suggest that different chromosomes often behave as if they were physically connected in interphase as well as mitosis. To address this paradox directly, we used a microsurgical technique to physically remove nucleoplasm or chromosomes from living cells under isotonic conditions. Using this approach, we found that pulling a single nucleolus or chromosome out from interphase or mitotic cells resulted in sequential removal of the remaining nucleoli and chromosomes, interconnected by a continuous elastic thread. Enzymatic treatments of interphase nucleoplasm and chromosome chains held under tension revealed that mechanical continuity within the chromatin was mediated by elements sensitive to DNase or micrococcal nuclease, but not RNases, formamide at high temperature, or proteases. In contrast, mechanical coupling between mitotic chromosomes and the surrounding cytoplasm appeared to be mediated by gelsolin-sensitive microfilaments. Furthermore, when ion concentrations were raised and lowered, both the chromosomes and the interconnecting strands underwent multiple rounds of decondensation and recondensation. As a result of these dynamic structural alterations, the mitotic chains also became sensitive to disruption by restriction enzymes. Ion-induced chromosome decondensation could be blocked by treatment with DNA binding dyes, agents that reduce protein disulfide linkages within nuclear matrix, or an antibody directed against histones. Fully decondensed chromatin strands also could be induced to recondense into chromosomes with pre-existing size, shape, number, and position by adding anti-histone antibodies. Conversely, removal of histones by proteolysis or heparin treatment produced chromosome decondensation which could be reversed by addition of histone H1, but not histones H2b or H3. These data suggest that DNA, its associated protein scaffolds, and surrounding cytoskeletal networks function as a structurally-unified system. Mechanical coupling within the nucleoplasm may coordinate dynamic alterations in chromatin structure, guide chromosome movement, and ensure fidelity of mitosis.

NASA Discipline Cell Biology↗

Regulation of body fluid volume and electrolyte concentrations in spaceflight

Despite a number of difficulties in performing experiments during weightlessness, a great deal of information has been obtained concerning the effects of spaceflight on the regulation of body fluid and electrolytes. Many paradoxes and questions remain, however. Although body mass, extracellular fluid volume, and plasma volume are reduced during spaceflight and remain so at landing, the changes in total body water are comparatively small. Serum or plasma sodium and osmolality have generally been unchanged or reduced during the spaceflight, and fluid intake is substantially reduced, especially during the first of flight. The diuresis that was predicted to be caused by weightlessness, has only rarely been observed as an increased urine volume. What has been well established by now, is the occurrence of a relative diuresis, where fluid intake decreases more than urine volume does. Urinary excretion of electrolytes has been variable during spaceflight, but retention of fluid and electrolytes at landing has been consistently observed. The glomerular filtration rate was significantly elevated during the SLS missions, and water and electrolyte loading tests have indicated that renal function is altered during readaptation to Earth's gravity. Endocrine control of fluid volumes and electrolyte concentrations may be altered during weightlessness, but levels of hormones in body fluids do not conform to predictions based on early hypotheses. Antidiuretic hormone is not suppressed, though its level is highly variable and its secretion may be affected by space motion sickness and environmental factors. Plasma renin activity and aldosterone are generally elevated at landing, consistent with sodium retention, but inflight levels have been variable. Salt intake may be an important factor influencing the levels of these hormones. The circadian rhythm of cortisol has undoubtedly contributed to its variability, and little is known yet about the influence of spaceflight on circadian rhythms. Atrial natriuretic peptide does not seem to play an important role in the control of natriuresis during spaceflight. Inflight activity of the sympathetic nervous system, assessed by measuring catecholamines and their metabolites and precursors in body fluids, generally seems to be no greater than on Earth, but this system is usually activated at landing. Collaborative experiments on the Mir and the International Space Station should provide more of the data needed from long-term flights, and perhaps help to resolve some of the discrepancies between U.S. and Russian data. The use of alternative methods that are easier to execute during spaceflight, such as collection of saliva instead of blood and urine, should permit more thorough study of circadian rhythms and rapid hormone changes in weightlessness. More investigations of dietary intake of fluid and electrolytes must be performed to understand regulatory processes. Additional hormones that may participate in these processes, such as other natriuretic hormones, should be determined during and after spaceflight. Alterations in body fluid volume and blood electrolyte concentrations during spaceflight have important consequences for readaptation to the 1-G environment. The current assessment of fluid and electrolyte status during weightlessness and at landing and our still incomplete understanding of the processes of adaptation to weightlessness and readaptation to Earth's gravity have resulted in the development of countermeasures that are only partly successful in reducing the postflight orthostatic intolerance experienced by astronauts and cosmonauts. More complete knowledge of these processes can be expected to produce countermeasures that are even more successful, as well as expand our comprehension of the range of adaptability of human physiologic processes.

NASA Discipline Number 18-10↗

Ulysses Observations of the Magnetic Connectivity between CMEs and the Sun

We have investigated the magnetic connectivity of coronal mass ejections (CMEs) to the Sun using Ulysses observations of suprathermal electrons at various distances between 1 AU and 5.2 AU. Drawing on ideas concerning the eruption and evolution of CMEs, we had anticipated that there might be a tendency for CMEs to contain progressively more open field lines, as reconnection back at the Sun either opened or completely disconnected previously closed field lines threading the CMEs. Our results, however, did not yield any discernible trend. By combining the potential contribution of CMEs to the heliospheric flux with the observed build-up of flux during the course of the solar cycle we also derive a lower limit for the reconnection rate of CMEs that is sufficient to avoid the "flux catastrophe" paradox. This rate is well below our threshold of detectability.

Riley, Pete↗

X-Ray Absorbed, Broad-Lined, Red AGN and the Cosmic X-Ray Background

We have obtained XMM spectra for five red, 2MASS AGN, selected from a sample observed by Chandra to be X-ray bright and to cover a range of hardness ratios. Our results confirm the presence of substantial absorbing material in three sources which have optical classifications ranging from Type 1 to Type 2, with an intrinsically flat (hard) power law continuum indicated in the other two. The presence of both X-ray absorption and broad optical emission lines with the usual strength suggests either a small (nuclear) absorber or a favored viewing angle so as to cover the X-ray source but not the broad emission line region (BELR). A soft excess is detected in all three Type 1 sources. We speculate that this soft X-ray emission may arise in an extended region of ionized gas, perhaps linked with the polarized (scattered) light which is a feature of these sources. The spectral complexity revealed by XMM emphasizes the limitations of the low S/N Chandra data. Overall, the new XMM results strengthen our conclusions (Wilkes et al. 2002) that the observed X-ray continua of red AGN are unusually hard at energies greater than 2 keV. Whether due to substantial line-of-sight absorption or to an intrinsically hard or reflection-dominated spectrum, these 'red' AGN have an observed spectral form consistent with contributing significantly to the missing had absorbed population of the Cosmic X-ray Background (CXRB). When absorption and or reflection is taken into account, all these AGN have power law slopes typical of broad-line (Type 1) AGN (Gamma approximately 1.9). This appears to resolve the spectral paradox which for so long has existed between the CXRB and the AGN thought to be the dominant contributors. It also suggests two scenarios whereby Type 1 AGN/QSOs may be responsible for a significant fraction of the CXRB at energies above 2 keV: 1) X-ray absorbed AGN/QSOs with visible broad emission lines; 2) AGN/QSOs with complex spectra whose hardness greater than 2 keV is not detectable in the typically low S/N data of X-ray surveys. Even if absorption is present in only half of the population, the large number of 'red' AGN suggests a development of unification models, where the continuum source is surrounded, over a substantial solid angle, by the wind or atmosphere of an accretion disk/torus. X-ray observations of such AGN not only provide a check on the presence of absorption, but also a unique probe of the absorbing material. Improved information on their space density, in particular as a function of redshift, will soon be provided by Spitzer-Chandra wide area surveys, allowing better estimates of both the importance of red AGN to the full AGN population and their contribution to the CXRB.

Mushotzky, Richard↗

Insights into Tropospheric Ozone from the INTEX Ozonesonde Network Study (IONS)

Ozone profile data from soundings integrate models, aircraft and other ground-based measurements for better interpretation of atmospheric chemistry and dynamics. A well-designed network of ozonesonde stations, with consistent sampling, can answer questions not possible with short campaigns or current satellite technology. The SHADOZ (Southern Hemisphere Additional Ozonesondes) project, for example, has led to these findings about tropical ozone: definition of the zonal tropospheric wave-one pattern in equatorial ozone, characterization of the "Atlantic ozone paradox" and establishment of a link between tropical Atlantic and Indian Ocean pollution. Building on the SHADOZ concept, a short-term ozone network was formed in July-August 2004 to coordinate ozonesonde launches during the ICARTT/INTEX/NEAQS (International Consortium on Atmospheric Research on Transport and Transformation)/Intercontinental Transport Experiment/New England Air Quality Study. In IONS (INTEX Ozonesonde Network Study), more than 250 soundings, with daily frequency at half the sites, were launched from eleven North American stations and an oceanographic ship in the Gulf of Maine. Although the goal was to examine pollution influences under stable high-pressure systems and transport associated with "warm conveyor belt" flows, the INTEX study region was dominated by a series of weak frontal system that mixed aged pollution with stratospheric ozone in the middle troposphere. Deconvoluting ozone sources provides new insights into ozone in the transition between mid-latitude and polar air.

Thompson, Anne M.↗

New Insights on Tropical Ozone from SHADOZ (Southern Hemisphere Additional Ozonesondes) Profiles

The SHADOZ (Southern Hemisphere Additional Ozonesondes) ozone sounding network was initiated in 1998 to improve the coverage of tropical in-situ ozone measurements for satellite validation, algorithm development and related process studies. Over 2000 soundings have been archived at the website, , for 12 stations: Ascension Island; Nairobi and Malindi, Kenya; Irene, South Africa; Reunion Island, Watukosek, Java; Fiji; Tahiti; American Samoa; San Cristobal, Galapagos; Natal, Brazil; Paramaribo, Surinam. Key results from SHADOZ will be described from among the following: 1) By using ECC sondes with similar procedures, 5-10% accuracy and precision (1-sigma) of the sonde total ozone measurement was achieved; 2) Week-to-week variability in tropospheric ozone is so great that statistics are frequently not Gaussian; most stations vary up to a factor of 3 in tropospheric column over the course of a year; 3) Longitudinal variability in tropospheric ozone profiles is a consistent feature, with a 10-15 DU column-integrated difference between Atlantic and Pacific sites; this causes a "zonal wave-one" feature in total ozone. 4) The ozone record from Paramaribo, Surinam (6N, 55W) is a marked contrast to southern tropical ozone because Surinam is often north of the Intertropical Convergence Zone; 5) Indian Ocean region pollution may contribute up to half of the excess ozone observed in the south tropical Atlantic paradox in the December-January-February period of the year.

Thompson, Anne M.↗

Technical Civilizations in the Galaxy

Are there other technical civilizations in the galaxy? Past analyses come to different conclusions. Cocconi and Morrison demonstrated in 1959 that interstellar radio communication was possible and Drake conducted the first search for beacons in 1960. The Drake equation estimates the number of galactic civilizations that are transmitting beacons as the product of the rate of star formation in the galaxy, the fraction of stars with planets, their average number of earthlike planets, the fraction with intelligent life and interstellar communication, and the average lifetime of a technical civilization. The Drake model of the galaxy contains many technical civilizations with communication but no interstellar travel. Michael Hart in 1975 strongly challenged this model. Starting with the fact that no extraterrestrials have been observed on Earth, and assuming that interstellar colonization is possible, he concluded that it was very likely that we are the first civilization in our galaxy and that searching or beacons is probably a waste of time and money. The Fermi paradox similarly reasons that if extraterrestrials exist: they should be here, and asks, Where are they? The Hart/Fermi model of the galaxy contains only our civilization and suggests we may colonize the galaxy. A third galactic model is that we are alone but will never develop interstellar travel. The fourth alternate model has many technical civilizations, with interstellar travel and colonization. The possibilities are clear and momentous. Either we are the only technical civilization in the galaxy or there are others. Technical civilizations will colonize the galaxy or not. We have four cosmic conjectures - one or many, colonization or not - but however unlikely they seem based on our limited evidence, one of these four models must be collect.

Jones, Harry↗

Formation of Martian Gullies by the Action of Liquid Water Flowing Under Current Martian Environmental Conditions

Images from the Mars Orbiter Camera (MOC) on the Mars Global Surveyor (MGS) spacecraft show geologically young small-scale features resembling terrestrial water-carved gullies. An improved understanding of these features has the potential to reveal important information about the hydrological system on Mars, which is of general interest to the planetary science community as well as the field of astrobiology and the search for life on Mars. The young geologic age of these gullies is often thought to be a paradox because liquid water is unstable at the Martian surface. Current temperatures and pressures are generally below the triple point of water (273 K, 6.1 mbar) so that liquid water will spontaneously boil and/or freeze. We therefore examine the flow of water on Mars to determine what conditions are consistent with the observed features of the gullies.

Heldmann, J. L.↗

Atmospheric Teleconnection over Eurasia Induced by Aerosol Radiative Forcing During Boreal Spring

The direct effects of aerosols on global and regional climate during boreal spring are investigated based on simulations using the NASA Global Modeling and Assimilation Office (GMAO) finite-volume general circulation model (fvGCM) with Microphyics of clouds in Relaxed Arakawa Schubert Scheme (McRAS). The aerosol loading are prescribed from three-dimensional monthly distribution of tropospheric aerosols viz., sulfate, black carbon, organic carbon, soil dust, and sea salt from output of the Goddard Ozone Chemistry Aerosol Radiation and Transport model (GOCART). The aerosol extinction coefficient, single scattering albedo, and asymmetric factor are computed as wavelength-dependent radiative forcing in the radiative transfer scheme of the fvGCM, and as a function of the aerosol loading and ambient relative humidity. We find that anomalous atmospheric heat sources induced by absorbing aerosols (dust and black carbon) excites a planetary scale teleconnection pattern in sea level pressure, temperature and geopotential height spanning North Africa through Eurasia to the North Pacific. Surface cooling due to direct effects of aerosols is found in the vicinity and downstream of the aerosol source regions, i.e., South Asia, East Asia, and northern and western Africa. Additionally, atmospheric heating is found in regions with large loading of dust (over Northern Africa, and Middle East), and black carbon (over South-East Asia). Paradoxically, the most pronounced feature in aerosol-induced surface temperature is an east-west dipole anomaly with strong cooling over the Caspian Sea, and warming over central and northeastern Asia, where aerosol concentration are low. Analyses of circulation anomalies show that the dipole anomaly is a part of an atmospheric teleconnection driven by atmospheric heating anomalies induced by absorbing aerosols in the source regions, but the influence was conveyed globally through barotropic energy dispersion and sustained by feedback processes associated with the regional circulations.

Kim, Maeng-Ki↗

Bidirectional Classical Stochastic Processes with Measurements and Feedback

A measurement on a quantum system is said to cause the "collapse" of the quantum state vector or density matrix. An analogous collapse occurs with measurements on a classical stochastic process. This paper addresses the question of describing the response of a classical stochastic process when there is feedback from the output of a measurement to the input, and is intended to give a model for quantum-mechanical processes that occur along a space-like reaction coordinate. The classical system can be thought of in physical terms as two counterflowing probability streams, which stochastically exchange probability currents in a way that the net probability current, and hence the overall probability, suitably interpreted, is conserved. The proposed formalism extends the . mathematics of those stochastic processes describable with linear, single-step, unidirectional transition probabilities, known as Markov chains and stochastic matrices. It is shown that a certain rearrangement and combination of the input and output of two stochastic matrices of the same order yields another matrix of the same type. Each measurement causes the partial collapse of the probability current distribution in the midst of such a process, giving rise to calculable, but non-Markov, values for the ensuing modification of the system's output probability distribution. The paper concludes with an analysis of a classical probabilistic version of the so-called grandfather paradox.

Hahne, G. E.↗

On Whether Angular Momentum in Electric and Magnetic Fields Radiates to Infinity

The Feynman Disk experiment and a related thought experiment with a static magnetic field and capacitor are studied. The mechanical torque integrated over time (angular impulse) is related to the angular momentum in the electric/magnetic field. This is not called an electromagnetic field since quasi-static as well as electromagnetic effects are included. The angular momentum in the electric/magnetic field is examined to determine its static and radiative components. This comparison was then examined to see if it clarified the Abraham-Minkowski paradox.

Canning, Francis X.↗

ULYSSES OBSERVATIONS OF THE MAGNETIC CONNECTIVITY BETWEEN CORONAL, MASS EJECTIONS AND THE SUN

We have investigated the magnetic connectivity of coronal mass ejections (CMEs) to the Sun using Ulysses observations of suprathermal electrons at various distances between 1 and 5.2 AU. Drawing on ideas concerning the eruption and evolution of CMEs, we had anticipated that there might be a tendency for CMEs to contain progressively more open field lines, as reconnection back at the Sun either opened or completely disconnected previously closed field lines threading the CMEs. Our results, however, did not yield any discernible trend. By combining the potential contribution of CMEs to the heliospheric flux with the observed buildup of flux during the course of the solar cycle, we also derive a lower limit for the reconnection rate of CMEs that is sufficient to avoid the "flux catastrophe" paradox. This rate is well below our threshold of detectability. Subject headings: solar wind - Sun: activity - Sun: corona - Sun: coronal mass ejections (CMEs) - On-line material: color figure Sun: magnetic fields

Riley, Pete↗

Role of Deep Convection in Establishing the Isotopic Composition of Water Vapor in the Tropical Transition Layer

The transport of H2O and HDO within deep convection is investigated with 3-D large eddy simulations (LES) using bin microphysics. The lofting and sublimation of HDO-rich ice invalidate the Rayleigh fractionation model of isotopologue distribution within deep convection. Bootstrapping the correlation of the ratio of HDO to H2O (deltaD) to water vapor mixing ratio (q(sub v)) through a sequence of convective events produced non-Rayleigh correlations resembling observations. These results support two mechanisms for stratospheric entry. Deep convection can inject air with water vapor of stratospheric character directly into the tropical transition layer (TTL). Alternatively, moister air detraining from convection may be dehydrated via cirrus formation n the TTL to produce stratospheric water vapor. Significant production of subsaturated air in the TTL via convective dehydration is not observed in these simulations, nor is it necessary to resolve the stratospheric isotope paradox.

Smith, Jamison A.↗

Advanced Electrocardiographic Predictors of Sudden Death in Familial Dysautonomia

To identify accurate predictors for the risk of sudden death in patients with familial dysautonomia (FD). Ten-minute resting high-fidelity 12-lead ECGs were obtained from 14 FD patients and 14 age/gender-matched healthy subjects. Multiple conventional and advanced ECG parameters were studied for their ability to predict sudden death in FD over a subsequent 4.5-year period, including multiple indices of linear and non-linear heart rate variability (HRV); QT variability; waveform complexity; high frequency QRS; and derived Frank-lead parameters. Four of the 14 FD patients died suddenly during the follow-up period, usually with concomitant pulmonary disorder. The presence of low vagally-mediated HRV was the ECG finding most predictive of sudden death. Concomitant left ventricular hypertrophy and other ECG abnormalities such as increased QTc and JTc intervals, spatial QRS-T angles, T-wave complexity, and QT variability were also present in FD patients, suggesting that structural heart disease is fairly common in FD. Although excessive or unopposed cardiac vagal (relative to sympathetic) activity has been postulated as a contributor to sudden death in FD, the presence of low vagally-mediated HRV was paradoxically the best predictor of sudden death. However, we suggest that low vagally-mediated HRV be construed not as a direct cause of sudden death in FD, but rather as an effect of concurrent pathological processes, especially hypoxia due to pulmonary disorders and sleep apnea, that themselves increase the risk of sudden death in FD and simultaneously diminish HRV. We speculate that adenosine may play a role in sudden death in FD, possibly independently of vagal activity, and that adenosine inhibitors such as theophylline might therefore be useful as prophylaxis in this disorder.

Solaimanzadeh, I.↗