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1 Radboud University Nijmegen Medical Centre
* To whom correspondence should be addressed. E-mail: i.krabbendam{at}obgyn.umcn.nl.
Head-up tilt (HUT) induces a reduction in preload, which is thought to be restored through sympathetic venoconstriction, reducing unstressed volume (Vu) and venous compliance (VeC). In this study, we assessed venous inflow and outflow responses, and their reproducibility, and determined the relation with autonomic function during HUT. Eight healthy non-pregnant women were subjected to 20° head-down to 60° head-up tilt (HUT), at 20° intervals. At each rotational step, we randomly assessed forearm volume-pressure curves (V-P curve; venous occlusion plethysmography) during venous inflow (VeCIN) and outflow (venous emptying rate; VEROUT). VeCIN was defined as the ratio of the slope of the volume-time curve and the pressure-time curve, with direct intravenous pressure measurement. VEROUT was determined using the derivate of a quadratic regression model, using cuff pressure. We defined Vu as the y-intercept of the V-P curve. We calculated for both methods the coefficients of reproducibility (CR) and variation (CV). Vascular sympathetic activity (LnLFsys) was determined by spectral analysis. VeCIN decreased at each rotational step, as compared to supine position (p<0.05), whereas VEROUT increased. CR of VeCIN was higher in supine position than VEROUT, but lower during HUT. CV varied between 19-25% (VeCIN) and 12-21% (VEROUT). HUT decreased Vu. The change in VeCIN and VEROUT correlated with the change in LnLFsys(r=-0.36, p<0.01 and r=0.48, p<0.01). This is the first study in which a reproducible reduction in VeCIN and unstressed volume and a rise in VEROUT during HUT are documented. The alterations in venous characteristics relate to changes in vascular sympathetic activity.
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I. Krabbendam, R. Scholten, and M. E. A. Spaanderman Reply to "Letter to the Editor: 'Does baroreflex unloading decrease limb venous compliance in women?'" Am J Physiol Heart Circ Physiol, February 1, 2009; 296(2): H535 - H535. [Full Text] [PDF] |
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