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Autonomic Neuromodulation Acutely Ameliorates Left Ventricular Strain in Humans

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Abstract

Low-level transcutaneous vagus nerve stimulation at the tragus (LLTS) is anti-adrenergic. We aimed to evaluate the acute effects of LLTS on left ventricular (LV) function and autonomic tone. Patients with diastolic dysfunction and preserved LV ejection fraction were enrolled in a prospective, randomized, double-blind, 2 × 2 cross-over study. Patients received two separate, 1-h sessions, at least 1 day apart, of active LLTS (20 Hz, 1 mA below the discomfort threshold) and sham stimulation. Echocardiography was performed after LLTS or sham stimulation to assess cardiac function. A 5-min ECG was performed to assess heart rate variability (HRV). Twenty-four patients were enrolled. LV global longitudinal strain improved by 1.8 ± 0.9% during active LLTS compared to sham stimulation (p = 0.001). Relative to baseline, HRV frequency domain components (low frequency, high frequency, and their ratio) were favorably altered after LLTS compared to sham stimulation (all p < 0.05). We concluded that LLTS acutely ameliorates cardiac mechanics by modulating the autonomic tone. Trial registration: NCT02983448

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Abbreviations

HFpEF:

Heart failure with preserved ejection fraction

LV:

Left ventricle

HFrEF:

Heart failure with reduced ejection fraction

VNS:

Vagus nerve stimulation

LLTS:

Low-level transcutaneous vagus nerve stimulation

TENS:

Transcutaneous electrical nerve stimulation

GLS:

Global longitudinal strain

HRV:

Heart rate variability

HF:

High frequency

LF:

Low frequency

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Funding

This study was funded by an Oklahoma Shared Clinical and Translational Resources pilot grant (NIGMS IDeA-CTR U54-GM104938) to Stavros Stavrakis.

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  1. University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd Suite, Oklahoma City, OK, 5400, USA

    Nicole Tran, Zain Asad, Khaled Elkholey, Benjamin J. Scherlag, Sunny S. Po & Stavros Stavrakis

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  1. Nicole Tran
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  2. Zain Asad
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Correspondence to Stavros Stavrakis.

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Human Subjects/Informed Consent Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Tran, N., Asad, Z., Elkholey, K. et al. Autonomic Neuromodulation Acutely Ameliorates Left Ventricular Strain in Humans. J. of Cardiovasc. Trans. Res. 12, 221–230 (2019). https://doi.org/10.1007/s12265-018-9853-6

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