Johannes Van Lieshout | Academic Medical Centre/ Universiteit van Amsterdam (original) (raw)

Papers by Johannes Van Lieshout

Am J Hypertens, 2013

Sodium nitroprusside (SNP) and labetalol are recommended for the immediate treatment of malignant... more Sodium nitroprusside (SNP) and labetalol are recommended for the immediate treatment of malignant hypertension. Both are intravenous agents but have different effects on systemic hemodynamics, and may have differential effects on pulse-wave reflection and pulse-pressure amplification, with consequences for peripheral versus central blood pressures (BPs).

Wieling. Leg crossing improves orthostatic tolerance in healthy subjects: a placebo-controlled cr... more Wieling. Leg crossing improves orthostatic tolerance in healthy subjects: a placebo-controlled crossover study. Vasovagal syncope is the most common cause of transient loss of consciousness, and recurrent vasovagal fainting has a profound impact on quality of life. Physical countermaneuvers are applied as a means of tertiary prevention but have so far only proven useful at the onset of a faint. This placebo-controlled crossover study tested the hypothesis that leg crossing increases orthostatic tolerance. Nine naïve healthy subjects [6 females, median age 25 yr (range 20 -41 yr), mean body mass index 23 (SD 2)] were subjected to passive head-up tilt combined with a graded lower body negative pressure challenge (20, 40, and 60 mmHg) determining orthostatic tolerance thrice, in randomized order: 1) control, 2) with leg crossing, and 3) with oral placebo. Blood pressure (Finometer), heart rate, and changes in thoracic blood volume (impedance), stroke volume, and cardiac output (Modelflow) were followed during orthostatic stress. Primary outcome was time to presyncope (systolic blood pressure Յ85 mmHg, heart rate Ն140 beats/min). With leg crossing, orthostatic tolerance increased from 26 Ϯ 2 to 34 Ϯ 2 min (placebo 23 Ϯ 3 min, P Ͻ 0.001). During leg crossing, mean arterial pressure (81 vs. 81 mmHg) and cardiac output (95 vs. 94% supine) remained unchanged; heart rate increase was lower (13 vs. 18 beats/min, P Ͻ 0.05); stroke volume was higher (79 vs. 74% supine, P Ͻ 0.05); and there was a trend toward lower thoracic impedance. Leg crossing increases orthostatic tolerance in healthy human subjects. As a measure of prevention, it is a worthwhile addition to the management of vasovagal syncope.

Journal of Applied Physiology, 2014

Journal of Applied Physiology, 2009

Immink RV, Truijen J, Secher NH, Van Lieshout JJ. Transient influence of end-tidal carbon dioxide... more Immink RV, Truijen J, Secher NH, Van Lieshout JJ. Transient influence of end-tidal carbon dioxide tension on the postural restraint in cerebral perfusion. In the upright position, cerebral blood flow is reduced, maybe because arterial carbon dioxide partial pressure (Pa CO 2 ) decreases. We evaluated the time-dependent influence of a reduction in Pa CO 2 , as indicated by the end-tidal PCO 2 tension (PETCO 2 ), on cerebral perfusion during head-up tilt. Mean arterial pressure, cardiac output, middle cerebral artery mean flow velocity (MCA V mean), and dynamic cerebral autoregulation at supine rest and 70°head-up tilt were determined during free breathing and with PET CO 2 clamped to the supine level. The postural changes in central hemodynamic variables were equivalent, and the cerebrovascular autoregulatory capacity was not significantly affected by tilt or by clamping PET CO 2 . In the first minute of tilt, the decline in MCA V mean (10 Ϯ 4 vs. 3 Ϯ 4 cm/s; mean Ϯ SE; P Ͻ 0.05) and PET CO 2 (6.8 Ϯ 4.3 vs. 1.7 Ϯ 1.6 Torr; P Ͻ 0.05) was larger during spontaneous breathing than during isocapnic tilt. However, after 2 min in the head-up position, the reduction in MCA V mean was similar (7 Ϯ 5 vs. 6 Ϯ 3 cm/s), although the spontaneous decline in PET CO 2 was maintained (P Ͻ 0.05 vs. isocapnic tilt). These results suggest that the potential contribution of Pa CO 2 to the postural reduction in MCA V mean is transient, leaving the mechanisms for the sustained restrain in MCA V mean to be identified. blood pressure; cardiac output; cerebral blood velocity

F1000 - Post-publication peer review of the biomedical literature, 2007

F1000 - Post-publication peer review of the biomedical literature, 2011

F1000 - Post-publication peer review of the biomedical literature, 2006

F1000 - Post-publication peer review of the biomedical literature, 2013

Diseases of The Colon & Rectum - DIS COLON RECTUM, 2003

The cardiovascular derangement that results from the administration of endotoxin in healthy subje... more The cardiovascular derangement that results from the administration of endotoxin in healthy subjects is qualitatively similar to what is observed in patients in septic shock. The biological response to endotoxin is attributed in part to cytokine release. In experimental endotoxemia, recombinant bactericidal/permeability increasing protein (rBPI 23 ) has shown a protective effect by binding endotoxin with the subsequent inhibition of the endotoxin-induced cytokine release and of neutrophil activation. In a controlled, blinded crossover study the early cardiovascular effects of rBPI 23 were investigated in an experimental endotoxemia model in humans. The beat-to-beat changes in arterial pressure and cardiac output following infusion of endotoxin (40 EU/kg body weight) and rBPI 23 (1 mg/kg) or placebo (human serum albumin, 0.2 mg/kg) were studied for 2 hours in 8 healthy male adults. Endotoxin or rBPI 23 alone did not induce significant cardiovascular changes. Endotoxin following rBPI 23 infusion elicited a fall in total peripheral resistance with its nadir after 4 minutes to 40% (range 16-53; P < .001) of control level. Mean arterial pressure showed little change, and the fall in total peripheral resistance was associated with a reflex increase in heart rate and cardiac output (32%; range 43-106). Changes in cardiovascular variables in the subsequent 2 hours were not significant. In vitro activation of the contact system by, respectively, rBPI 23 , LPS, and LPS-rBPI 23 complexes was assessed. Following incubation with rBPI 23 , LPS, and LPS-rBPI 23 complexes, complex levels were generated at levels comparable to those observed in the buffer control. The rapid vasodilatation by endotoxin administered concomitantly with rBPI 23 is not mediated by complement or contact system activation. The early vasodilatation is compensated by an increase in cardiac output, which therefore does not result in arterial hypotension. The monitoring of continuous cardiac output allows for the detection of rapid effects on systemic flow and conductance that go unnoticed in a recording of arterial pressure. (J Lab Clin Med 2002;140:228-35) Abbrevations: BPI ϭ bactericidal/permeability increasing protein; CO ϭ cardiac output; C w ϭ arterial compliance; EU ϭ endotoxin unit; HR ϭ heart rate; LPS ϭ lipopolysaccharide; rBPI 23 ϭ recombinant BPI; R p ϭ peripheral vascular resistance; SV ϭ stroke volume; TPR ϭ total peripheral resistance; Z 0 ϭ aortic characteristic impedance

Clinical Science, Nov 1, 2007

A B S T R A C T IOH (initial orthostatic hypotension) comprises symptoms of cerebral hypoperfusio... more A B S T R A C T IOH (initial orthostatic hypotension) comprises symptoms of cerebral hypoperfusion caused by an abnormally large transient MAP (mean arterial pressure) decrease 5-15 s after arising from a supine, sitting or squatting position. Few treatment options are available. In the present study, we set out to test the hypothesis that LBMT (lower body muscle tensing) attenuates IOH after rising from squatting and its symptoms in daily life. A total of 13 IOH patients (nine men; median age, 27 years) rose from squatting twice, once with LBMT and once without. In addition, seven healthy volunteers (five men; median age, 27 years) were studied in a cross-over study design. They stood up from the squatting position three times, once combined with LBMT. Blood pressure (Finometer) was measured continuously, and CO (cardiac output) by Modelflow and TPR (total peripheral resistance) were computed. MAP, CO and TPR were compared without and with LBMT. Using a questionnaire, the perceived effectiveness of LBMT in the patients' daily lives was evaluated. With LBMT, the minimal MAP after standing up was higher in both groups (19 mmHg in patients and 13 mmHg in healthy subjects). In healthy subjects, the underlying mechanism was a blunted TPR decrease (to 47 % compared with 60 %; P < 0.05), whereas in the patients no clear CO or TPR pattern was discernible. During follow-up, eight out of ten patients using LBMT reported fewer IOH symptoms. In conclusion, LBMT is a new intervention to attenuate the transient blood pressure decrease after standing up from squatting, and IOH patients should be advised about the use of this manoeuvre.

The Netherlands Journal of Medicine

1. Two patients are described who presented with orthostatic hypotension as the main symptom. The... more 1. Two patients are described who presented with orthostatic hypotension as the main symptom. The diagnosis was sympathetic failure with intact vagal control. 2. Unusual test results were obtained. Assessment of the integrity of the total baroreflex arc by the Valsalva manoeuvre measuring only heart rate changes proved impossible, since the magnitude and time course of the heart rate response were normal notwithstanding the presence of a blood pressure response typical of sympathetic failure. 3. Sustained handgrip, cold pressor test and mental stress test all could induce a rise in blood pressure, despite the presence of sympathetic vasomotor lesions, but only when accompanied by a rise in heart rate. Efferent parasympathetic blockade by atropine, resulting in an increase in heart rate, was also accompanied by a substantial rise in blood pressure. These findings seem to result from a heart rate rise dependent increase in cardiac output unopposed by reflex vasodilatation. 4. In these patients the only baroreflex way to control blood pressure is by varying heart rate. This condition can be evaluated only if blood pressure and heart rate are measured on a beat-by-beat basis.

The Netherlands Journal of Medicine

We studied sympathetic cardiovascular control in a patient after sympathectomies and found severe... more We studied sympathetic cardiovascular control in a patient after sympathectomies and found severe hypoadrenergic orthostatic hypotension before and after, but not during upright exercise. This report is the first to correlate in man anatomical sympathetic lesions with autonomic function test results and to document that in a sequence of sympathectomies orthostatic hypotension does not develop until the major part of splanchnic sympathetic outflow is destroyed.

PLOS ONE, 2015

Pulse (PPV) and systolic pressure variation (SPV) quantify variations in arterial pressure relate... more Pulse (PPV) and systolic pressure variation (SPV) quantify variations in arterial pressure related to heart-lung interactions and have been introduced as biomarkers of preload dependency to guide fluid treatment in mechanically ventilated patients. However, respiratory intra-thoracic pressure changes during spontaneous breathing are considered too small to affect preload and stroke volume sufficiently for the detection by PPV and/or SPV. This study addressed the effects of paced breathing and/or an external respiratory resistance on PPV and SPV in detecting preload dependency in spontaneously breathing subjects. In 10 healthy subjects, hemodynamic and respiratory parameters were evaluated during progressive central hypovolemia (head-up tilt). Breathing conditions were varied by manipulating breathing frequency and respiratory resistance. Subjects responding with a reduction in stroke volume index ≥15% were classified as having developed preload dependency. The ability for PPV and SPV to predict preload dependency was expressed by the area under the ROC curve (AUC). A breathing frequency at 6/min increased the PPV (16±5% vs. 10±3%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and SPV (9±3% vs. 5±2%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) which was further enhanced by an expiratory resistance (PPV: 19±3%, p = 0.025 and SPV: 10±2%, p = 0.047). These respiratory modifications, compared to free breathing, enhanced the predictive value of PPV with higher accuracy (AUC: 0.92 vs. 0.46). Under conditions of progressive central hypovolemia, the application of an external respiratory resistance at a breathing frequency of 6/min enhanced PPV and SPV and is worth further study for detection of preload dependency from arterial pressure variations in non-ventilated subjects.

Clinical science (London, England : 1979), 2003

Journal of applied physiology (Bethesda, Md. : 1985), 2009

The Evaluation and Treatment of Syncope, 2006

Am J Hypertens, 2013

Sodium nitroprusside (SNP) and labetalol are recommended for the immediate treatment of malignant... more Sodium nitroprusside (SNP) and labetalol are recommended for the immediate treatment of malignant hypertension. Both are intravenous agents but have different effects on systemic hemodynamics, and may have differential effects on pulse-wave reflection and pulse-pressure amplification, with consequences for peripheral versus central blood pressures (BPs).

Wieling. Leg crossing improves orthostatic tolerance in healthy subjects: a placebo-controlled cr... more Wieling. Leg crossing improves orthostatic tolerance in healthy subjects: a placebo-controlled crossover study. Vasovagal syncope is the most common cause of transient loss of consciousness, and recurrent vasovagal fainting has a profound impact on quality of life. Physical countermaneuvers are applied as a means of tertiary prevention but have so far only proven useful at the onset of a faint. This placebo-controlled crossover study tested the hypothesis that leg crossing increases orthostatic tolerance. Nine naïve healthy subjects [6 females, median age 25 yr (range 20 -41 yr), mean body mass index 23 (SD 2)] were subjected to passive head-up tilt combined with a graded lower body negative pressure challenge (20, 40, and 60 mmHg) determining orthostatic tolerance thrice, in randomized order: 1) control, 2) with leg crossing, and 3) with oral placebo. Blood pressure (Finometer), heart rate, and changes in thoracic blood volume (impedance), stroke volume, and cardiac output (Modelflow) were followed during orthostatic stress. Primary outcome was time to presyncope (systolic blood pressure Յ85 mmHg, heart rate Ն140 beats/min). With leg crossing, orthostatic tolerance increased from 26 Ϯ 2 to 34 Ϯ 2 min (placebo 23 Ϯ 3 min, P Ͻ 0.001). During leg crossing, mean arterial pressure (81 vs. 81 mmHg) and cardiac output (95 vs. 94% supine) remained unchanged; heart rate increase was lower (13 vs. 18 beats/min, P Ͻ 0.05); stroke volume was higher (79 vs. 74% supine, P Ͻ 0.05); and there was a trend toward lower thoracic impedance. Leg crossing increases orthostatic tolerance in healthy human subjects. As a measure of prevention, it is a worthwhile addition to the management of vasovagal syncope.

Journal of Applied Physiology, 2014

Journal of Applied Physiology, 2009

Immink RV, Truijen J, Secher NH, Van Lieshout JJ. Transient influence of end-tidal carbon dioxide... more Immink RV, Truijen J, Secher NH, Van Lieshout JJ. Transient influence of end-tidal carbon dioxide tension on the postural restraint in cerebral perfusion. In the upright position, cerebral blood flow is reduced, maybe because arterial carbon dioxide partial pressure (Pa CO 2 ) decreases. We evaluated the time-dependent influence of a reduction in Pa CO 2 , as indicated by the end-tidal PCO 2 tension (PETCO 2 ), on cerebral perfusion during head-up tilt. Mean arterial pressure, cardiac output, middle cerebral artery mean flow velocity (MCA V mean), and dynamic cerebral autoregulation at supine rest and 70°head-up tilt were determined during free breathing and with PET CO 2 clamped to the supine level. The postural changes in central hemodynamic variables were equivalent, and the cerebrovascular autoregulatory capacity was not significantly affected by tilt or by clamping PET CO 2 . In the first minute of tilt, the decline in MCA V mean (10 Ϯ 4 vs. 3 Ϯ 4 cm/s; mean Ϯ SE; P Ͻ 0.05) and PET CO 2 (6.8 Ϯ 4.3 vs. 1.7 Ϯ 1.6 Torr; P Ͻ 0.05) was larger during spontaneous breathing than during isocapnic tilt. However, after 2 min in the head-up position, the reduction in MCA V mean was similar (7 Ϯ 5 vs. 6 Ϯ 3 cm/s), although the spontaneous decline in PET CO 2 was maintained (P Ͻ 0.05 vs. isocapnic tilt). These results suggest that the potential contribution of Pa CO 2 to the postural reduction in MCA V mean is transient, leaving the mechanisms for the sustained restrain in MCA V mean to be identified. blood pressure; cardiac output; cerebral blood velocity

F1000 - Post-publication peer review of the biomedical literature, 2007

F1000 - Post-publication peer review of the biomedical literature, 2011

F1000 - Post-publication peer review of the biomedical literature, 2006

F1000 - Post-publication peer review of the biomedical literature, 2013

Diseases of The Colon & Rectum - DIS COLON RECTUM, 2003

The cardiovascular derangement that results from the administration of endotoxin in healthy subje... more The cardiovascular derangement that results from the administration of endotoxin in healthy subjects is qualitatively similar to what is observed in patients in septic shock. The biological response to endotoxin is attributed in part to cytokine release. In experimental endotoxemia, recombinant bactericidal/permeability increasing protein (rBPI 23 ) has shown a protective effect by binding endotoxin with the subsequent inhibition of the endotoxin-induced cytokine release and of neutrophil activation. In a controlled, blinded crossover study the early cardiovascular effects of rBPI 23 were investigated in an experimental endotoxemia model in humans. The beat-to-beat changes in arterial pressure and cardiac output following infusion of endotoxin (40 EU/kg body weight) and rBPI 23 (1 mg/kg) or placebo (human serum albumin, 0.2 mg/kg) were studied for 2 hours in 8 healthy male adults. Endotoxin or rBPI 23 alone did not induce significant cardiovascular changes. Endotoxin following rBPI 23 infusion elicited a fall in total peripheral resistance with its nadir after 4 minutes to 40% (range 16-53; P < .001) of control level. Mean arterial pressure showed little change, and the fall in total peripheral resistance was associated with a reflex increase in heart rate and cardiac output (32%; range 43-106). Changes in cardiovascular variables in the subsequent 2 hours were not significant. In vitro activation of the contact system by, respectively, rBPI 23 , LPS, and LPS-rBPI 23 complexes was assessed. Following incubation with rBPI 23 , LPS, and LPS-rBPI 23 complexes, complex levels were generated at levels comparable to those observed in the buffer control. The rapid vasodilatation by endotoxin administered concomitantly with rBPI 23 is not mediated by complement or contact system activation. The early vasodilatation is compensated by an increase in cardiac output, which therefore does not result in arterial hypotension. The monitoring of continuous cardiac output allows for the detection of rapid effects on systemic flow and conductance that go unnoticed in a recording of arterial pressure. (J Lab Clin Med 2002;140:228-35) Abbrevations: BPI ϭ bactericidal/permeability increasing protein; CO ϭ cardiac output; C w ϭ arterial compliance; EU ϭ endotoxin unit; HR ϭ heart rate; LPS ϭ lipopolysaccharide; rBPI 23 ϭ recombinant BPI; R p ϭ peripheral vascular resistance; SV ϭ stroke volume; TPR ϭ total peripheral resistance; Z 0 ϭ aortic characteristic impedance

Clinical Science, Nov 1, 2007

A B S T R A C T IOH (initial orthostatic hypotension) comprises symptoms of cerebral hypoperfusio... more A B S T R A C T IOH (initial orthostatic hypotension) comprises symptoms of cerebral hypoperfusion caused by an abnormally large transient MAP (mean arterial pressure) decrease 5-15 s after arising from a supine, sitting or squatting position. Few treatment options are available. In the present study, we set out to test the hypothesis that LBMT (lower body muscle tensing) attenuates IOH after rising from squatting and its symptoms in daily life. A total of 13 IOH patients (nine men; median age, 27 years) rose from squatting twice, once with LBMT and once without. In addition, seven healthy volunteers (five men; median age, 27 years) were studied in a cross-over study design. They stood up from the squatting position three times, once combined with LBMT. Blood pressure (Finometer) was measured continuously, and CO (cardiac output) by Modelflow and TPR (total peripheral resistance) were computed. MAP, CO and TPR were compared without and with LBMT. Using a questionnaire, the perceived effectiveness of LBMT in the patients' daily lives was evaluated. With LBMT, the minimal MAP after standing up was higher in both groups (19 mmHg in patients and 13 mmHg in healthy subjects). In healthy subjects, the underlying mechanism was a blunted TPR decrease (to 47 % compared with 60 %; P < 0.05), whereas in the patients no clear CO or TPR pattern was discernible. During follow-up, eight out of ten patients using LBMT reported fewer IOH symptoms. In conclusion, LBMT is a new intervention to attenuate the transient blood pressure decrease after standing up from squatting, and IOH patients should be advised about the use of this manoeuvre.

The Netherlands Journal of Medicine

1. Two patients are described who presented with orthostatic hypotension as the main symptom. The... more 1. Two patients are described who presented with orthostatic hypotension as the main symptom. The diagnosis was sympathetic failure with intact vagal control. 2. Unusual test results were obtained. Assessment of the integrity of the total baroreflex arc by the Valsalva manoeuvre measuring only heart rate changes proved impossible, since the magnitude and time course of the heart rate response were normal notwithstanding the presence of a blood pressure response typical of sympathetic failure. 3. Sustained handgrip, cold pressor test and mental stress test all could induce a rise in blood pressure, despite the presence of sympathetic vasomotor lesions, but only when accompanied by a rise in heart rate. Efferent parasympathetic blockade by atropine, resulting in an increase in heart rate, was also accompanied by a substantial rise in blood pressure. These findings seem to result from a heart rate rise dependent increase in cardiac output unopposed by reflex vasodilatation. 4. In these patients the only baroreflex way to control blood pressure is by varying heart rate. This condition can be evaluated only if blood pressure and heart rate are measured on a beat-by-beat basis.

The Netherlands Journal of Medicine

We studied sympathetic cardiovascular control in a patient after sympathectomies and found severe... more We studied sympathetic cardiovascular control in a patient after sympathectomies and found severe hypoadrenergic orthostatic hypotension before and after, but not during upright exercise. This report is the first to correlate in man anatomical sympathetic lesions with autonomic function test results and to document that in a sequence of sympathectomies orthostatic hypotension does not develop until the major part of splanchnic sympathetic outflow is destroyed.

PLOS ONE, 2015

Pulse (PPV) and systolic pressure variation (SPV) quantify variations in arterial pressure relate... more Pulse (PPV) and systolic pressure variation (SPV) quantify variations in arterial pressure related to heart-lung interactions and have been introduced as biomarkers of preload dependency to guide fluid treatment in mechanically ventilated patients. However, respiratory intra-thoracic pressure changes during spontaneous breathing are considered too small to affect preload and stroke volume sufficiently for the detection by PPV and/or SPV. This study addressed the effects of paced breathing and/or an external respiratory resistance on PPV and SPV in detecting preload dependency in spontaneously breathing subjects. In 10 healthy subjects, hemodynamic and respiratory parameters were evaluated during progressive central hypovolemia (head-up tilt). Breathing conditions were varied by manipulating breathing frequency and respiratory resistance. Subjects responding with a reduction in stroke volume index ≥15% were classified as having developed preload dependency. The ability for PPV and SPV to predict preload dependency was expressed by the area under the ROC curve (AUC). A breathing frequency at 6/min increased the PPV (16±5% vs. 10±3%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and SPV (9±3% vs. 5±2%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) which was further enhanced by an expiratory resistance (PPV: 19±3%, p = 0.025 and SPV: 10±2%, p = 0.047). These respiratory modifications, compared to free breathing, enhanced the predictive value of PPV with higher accuracy (AUC: 0.92 vs. 0.46). Under conditions of progressive central hypovolemia, the application of an external respiratory resistance at a breathing frequency of 6/min enhanced PPV and SPV and is worth further study for detection of preload dependency from arterial pressure variations in non-ventilated subjects.

Clinical science (London, England : 1979), 2003

Journal of applied physiology (Bethesda, Md. : 1985), 2009

The Evaluation and Treatment of Syncope, 2006