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Background: Type 2 diabetes mellitus (T2DM) leads to cardiac autonomic neuropathy (CAN), affecting blood flow and heart rate regulation eventually causing chronic stable angina (CSA). Percutaneous coronary intervention (PCI) can correct autonomic dysfunctions and improve myocardial perfusion. This study aimed to assess CAN using heart rate variability (HRV) and cardiovascular reflex tests in T2DM patients with CSA before and after PCI., Material and Methods: From cardiology outpatient clinics, 30 patients with T2DM with CSA were recruited. Before and after PCI, the following HRV parameters like low frequency (LF), high frequency (HF), LF:HF ratio, total power (TP), square root of mean square differences of successive R-R intervals (RMSSD), standard deviation of normal R-R intervals (SDNN), and percentage of adjacent NN intervals that differ from each other by more than 50 seconds (pNN50) were measured for every patient. Cardiovascular reflex tests, including the deep breathing test, the isometric handgrip test, the 30:15 ratio, the Valsalva ratio, and the lying-to-standing test (LST), were performed on the patients both before and after PCI. SPSS version 21.0 (IBM Corp., Armonk, NY), a licensed statistical program, was used to compile and analyze the data., Results: When compared to the pre-PCI group, 30 patients with T2DM with CSA, age range between 45 and 70 years, both genders demonstrated a significant increase in post-PCI HRV frequency domain parameters, such as LF (239.52±67.21ms 2 vs. 307.62±74.17 ms 2 ) and HF (249±25.21 ms 2 vs. 379.67±76.55 ms 2 ). The time domain parameters showed a significant increase in post-PCI values compared to pre-PCI values. These included RMSSD (33.97±3.96 ms vs. 8.005±3.25 ms), SDNN (41.4±9.78 vs. 31.74±7.04ms), NN50 (13.241±3.07 vs. 5.20±6.63), and TP (1130.08±320.10 ms 2 vs. 754.54±96.93 ms 2 ). In cardiovascular reflex tests, pre-PCI groups had significantly lower delta HR (DBT) (10.47±1.76 bpm vs. 14.20±2.09), E:I ratio (DBT) (1.14±0.042 vs. 1.20±0.026), and Valsalva ratio (1.10±0.071 vs. 1.22±0.084) than post-PCI groups. The pre-PCI group showed a substantial decrease in both the systolic blood pressure (LST) (-6.13±4.85 mmHg vs. -1.01±3.63 mmHg) and the 30:15 ratio (1.13±0.074 vs. 1.09±0.067) when compared to the post-PCI group. The handgrip test (18.73±4.31 mmHg vs. 15.31±4.27 mmHg) did not yield statistically significant results., Conclusions: Before PCI, T2DM patients with CSA experienced autonomic dysfunction, but after revascularization, their functions improved by reestablishing basal cardiac autonomic tone and autonomic reactivity. HRV and cardiovascular reflex tests are useful noninvasive tools for assessing CAN and stratifying a prospective risk factor for estimating the morbidity and death from cardiovascular illnesses in T2DM with CSA., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institute Ethics Committee of Vardhman Mahavir Medical College and Safdarjung Hospital issued approval IEC/VMMC/SJH/Thesis/October/2017-177. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alauddin et al.)

Introduction The risk of sudden death in patients with chronic coronary syndrome (CCS) is increased by unbalanced cardiovascular autonomic function. Since myocardial ischemia appears to be the cause of this condition of autonomic dysregulation, treating this condition should improve and correct the autonomic functions. Improving myocardial perfusion by PCI might have beneficial effects on the recovery of autonomic balance in ischemia-triggered autonomic dysregulation. Objective In the present study, autonomic modulation in patients with CCS was evaluated before and after percutaneous coronary intervention (PCI) using cardiovascular reflex tests. Methods A total of 30 CCS patients were recruited from the cardiology outpatient department. The patients were tested with cardiovascular reflex tests (lying to standing, 30:15 ratio, Valsalva ratio, isometric handgrip test, and deep breathing test) before and after PCI. The licensed statistical software SPSS version 21.0 was used to compile and analyse the data. Results Out of 30 patients, parasympathetic reactivity tests conducted post-PCI were significantly higher as compared to pre-PCI patients: (1) lying to standing - 30:15 ratio (1.17± 0.102 versus 1.03± 0.064, p=0.000); (2) Valsalva ratio (1.42±0.276 versus 1.02±0.133, p=0.000), (3) delta heart rate in deep breathing test (17.23± 3.004 bpm versus 7.85± 4.076 bpm, p=0.000), and (4) expiration to inspiration (E:I) ratio (1.25± 0.050 versus 1.11± 0.064, p=0.000. Among sympathetic reactivity tests, lying to standing test for fall in systolic blood pressure was significantly higher in the pre-PCI state than post-PCI (-20.73± 10.29 versus -2.33± 7.67, p=0.000). The rise in DBP of the isometric handgrip test was significantly higher in post-PCI compared to pre-PCI patients (36.73±8.39 mm Hg versus 16.63±8.47 mm Hg, p=0.000). Conclusion Resting autonomic tone as determined by cardiovascular reflex testing reveals an increase in both parasympathetic and sympathetic reactivity following PCI in CCS, according to the findings of this preliminary study. As a result, we propose that noninvasive procedures like cardiovascular reflex tests be used to stratify the likelihood of illness development in the future., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee, Vardhman Mahavir Medical College and Safdarjung Hospital issued approval IEC/VMMC/SJH/Thesis/October/2017-177. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alauddin et al.)

Background: Ehlers-Danlos syndrome (EDS) may be linked to dysfunction in the autonomic nervous system, affecting collagen production and processing. These collagen abnormalities lead to a condition called dysautonomia. Findings underscore the need for further investigation into autonomic nervous system function in EDS which involves larger studies to strengthen the evidence of non-invasive screening tools like cardiovascular reflex tests. These tests might offer a valuable way to assess an individual's risk for future complications., Objective: This study aimed to assess autonomic reactivity in EDS patients using cardiovascular reflex tests., Methods: This study was conducted at the Department of Physiology, Naraina Medical College and Research Centre, Kanpur (Uttar Pradesh). The cardiovascular reflex test was used to identify 60 individuals, 30 of whom were EDS patients and 30 were healthy controls, with a common age limit of 18-25 years. Cardiovascular reflex tests, such as the delta heart rate, lying-to-standing test (LST), deep breathing test (DBT), and Valsalva maneuver, were performed and recorded for each subject. IBM SPSS Statistics for Windows, Version 21.0 (Released 2012; IBM Corp., Armonk, New York, United States) was used for the compilation and analysis of data., Results: The expiration-to-inspiration (E:I) ratio and delta heart rate of the EDS patients both significantly decreased as compared to the healthy control group (1.10±0.02 versus 1.22±0.77 and 14.03±0.31 versus 15.52±0.32). The Valsalva ratio of the EDS patients decreased (1.28±0.01) as compared to the healthy control group (1.46±0.01), which was statistically significant. The 30:15 ratio in the EDS patients was significantly decreased compared to the healthy control group (1.08±0.01 versus 1.15±0.01). The handgrip test and cold pressor test results were statistically insignificant., Conclusion: The study suggests a connection between EDS and autonomic nervous system dysfunction, causing symptoms like tachycardia and hypotension. It recommends exploring non-invasive cardiovascular reflex tests as a tool to identify autonomic dysfunction in EDS patients and predict long-term cardiovascular complications. These tests offer valuable insights into autonomic function., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethical Committee of Naraina Medical College and Research Centre issued approval NMCRC/IEC/2023/012. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alauddin et al.)

Background: A considerable link between personality types and cardiovascular diseases (CVDs) has been seen. Autonomic responses in both type A and type B personality individuals were found to be influenced by their personality traits. The study suggests further research on cardiac autonomic functions in larger sample sizes and the use of non-invasive screening techniques like cardiovascular reflex tests to stratify participants' risk of future illness., Objective: This study aimed to assess autonomic stress reactivity tests in type A and type B personalities using cardiovascular reflex tests., Methods: This study was conducted at the Department of Physiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. The Hunter-Wolf Personality Questionnaire Scale was used to identify 60 adults, 30 of whom were classified to have type A personality and 30 have type B personality, from the psychiatry department. Autonomic function tests, such as the handgrip tests, cold pressor test, deep breathing test (DBT), lying-to-standing test (LST), and Valsalva maneuver, were performed and recorded for each subject. IBM SPSS Statistics for Windows, version 21 (released 2012; IBM Corp., Armonk, New York, United States) was used for the compilation and analysis of data., Results:  The E:I (expiration-to-inspiration) ratio and delta heart rate of the type A personality patients both significantly decreased (p = 0.000*) as compared to the type B personality patients (1.18 ± 0.03 versus 1.25 ± 0.77 and 1.18 ± 0.03 versus 1.25 ± 0.77). The Valsalva ratio of the type A personality patients decreased (1.38 ± 0.10) as compared to the type B personality patients (1.48 ± 0.18), which was statistically significant (p = 0.001*). The 30:15 ratio in the type A personality patients was significantly decreased (p = 0.03*) compared to the type B personality patients (1.12 ± 0.05 versus 1.15 ± 0.10). The handgrip test and cold pressor test results were statistically insignificant., Conclusion: Compared to the type B personality patients, which exhibited an increase in both parasympathetic and sympathetic reactivity, the type A personality patients exhibited a reduction in resting cardiovascular parameters and resting autonomic tone. Consequently, in order to stratify the participants' risk of future illness, we recommend employing non-invasive procedures, such as cardiovascular reflex tests, as a screening technique., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Bharti et al.)