2016 AAPB Webinar 8: Psychophysiologic Remodeling in Cardiovascular Disease
Presented by Jon Bale, Application Specialist, Thought Technology
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Cardiovascular disease involves autonomic dysregulation. It has long been established that sympathetic drive is over activated in patients with cardiovascular disease, seeking to compensate for decreased pumping ability of the failing heart. More recently, cardiologists and cardiovascular scientists have begun to understand that parasympathetic withdrawal is equally important in the pathophysiology of chronic cardiac conditions. While the sympathetic brancho of the autonomic nervous system is overactivated, the parasympathetic is under active. This observation has led to invasive therapies, such as direct vagal nerve stimulation, now being used in patients. We hypothesized that patients could be taught to regulate their own autonomic nervous systems, using biofeedback-mediated stress management, and could thereby decrease activity of the sympathetic branch and increase the contribution of the parasympathetic branch, leading to better autonomic balance. To test this hypothesis, we enrolled a population of patients with end-stage heart failure, waiting for heart transplantation. We administered a psychophysiologic stress assessment, together with questionnaires related to quality of life, and we drew blood for measurement of plasma norepinephrine. Following the initial assessment, patients received six biofeedback training sessions, either in their hospital room or in the clinical research unit, conducted by a healthy psychology postdoctoral fellow who was certified in biofeedback. The final stress assessment was conducted after completion of the training, and included the same elements as the initial stress assessment. When the patients received a heart transplant, we obtained the old heart in the operating room, returned it to the laboratory, and conducted biological experiments on the heart tissue, measuring markers of sympathetic and parasympathetic activation. Data from the study revealed that patients enjoyed the biofeedback training, cardiologists felt it was beneficial to their patients, and the training resulted in biological remodeling within the myocardium, with both sympathetic and parasympathetic markers recovering towards normal levels.
Professionals who complete this webinar will gain:
- Explain the underlying causes of autonomic nervous system imbalance in cardiac disease.
- Explain how autonomic nervous system activity is measured in patients and in heart tissues from patients.
- Discuss the mechanisms by which biofeedback-mediated stress management can have effects on autonomic nervous system balance.
- Discuss the data which demonstrate that biofeedback-mediated stress management had biological effects in our study of patients with end-stage heart failure .
Prerequisites: None. Advance preparation is not required.
Christine S Moravec, PhD is a cardiovascular physiologist with expertise in cardiac muscle physiology and autonomic nervous system regulation. She serves as Director of Basic Research for the Kaufman Center for Heart Failure at Cleveland Clinic. Her research focuses on human heart failure and the possibility that the cellular and molecular changes observed in the failing heart can be reversed, by medical or surgical intervention. Together with Dr. Michael McKee, she also investigates the hypothesis that physiologic self-regulation with biofeedback can be used by patients to modulate their own autonomic nervous system, and reverse some of the clinical correlates and biological remodeling associated with chronic cardiac disease. Dr. Moravec also serves as the Director of Basic Science Education for the Cleveland Clinic Lerner College of Medicine, Director of PhD Programs for the Cleveland Clinic Lerner Research Institute, and President of the Northeastern Ohio Science and Engineering Fair.