Periosteal Pressure Sensitivity of the chest bone as a measure for autonomic function in ischemic heart disease

Nanna Ørsted¹Søren Ballegaard^2*Jesper Kristiansen³Finn Gyntelberg³Ake Hjalmarson⁴Jens Faber^5,6

• ¹Department of Chemistry, Technical University of Denmark, Kongens Lyngby, Denmark
• ²Ballegaard Ltd. Copenhagen, Skodsborg, Denmark
• ³National Research Center for Work Environment, Copenhagen, Denmark
• ⁴Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
• ⁵Department of Endocrinology, Herlev University Hospital, Herlev, Denmark
• ⁶Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark

Purpose: In 177 patients with ischemic heart disease and elevated periosteal pain sensitivity of the chest bone indicative of autonomic nervous system dysfunction, we test the hypotheses, (i) there is an association between the tilt table responses for the baroreflex-mediated cardiovascular response heart rate variability and periosteal pain sensitivity of the chest bone, (ii) these responses are affected differently by use of beta blockade medication, and (iii) reduction of an elevated periosteal pain sensitivity of the chest bone, during three months of non-pharmacological intervention, improves these responses to tilt table testing. Results: Baroreflex-mediated cardiovascular response, heart rate variability and periosteal pain sensitivity measures all changed significantly in response to tilt table test but only periosteal pain sensitivity and baroreflex-mediated cardiovascular responses were internally associated. Use of beta blockade medication inhibited the baroreflex-mediated cardiovascular response and heart rate variability responses but did not of periosteal pain sensitivity. In response to three months intervention with the aim to reduce the elevated periosteal pressure pain, all responses to tilt table test improved, but for the baroreflex-mediated cardiovascular response and heart variability in nonusers of beta blockade, only. Participants who achieved a predefined minimum reduction of 15 units in periosteal pain sensitivity demonstrated significant improvement when compared to participants did not obtain this reduction. Conclusions: Periosteal pressure sensitivity of the chest bone at rest as well as the response to tilt table test seem new and promising measures of autonomic nervous system dysfunction, which remains unaffected by BB medication.