{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:10:51Z","timestamp":1791587451119,"version":"4.3.4"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T00:00:00Z","timestamp":1758412800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Increased variability in central aortic systolic pressure (CASP) and pulse pressure (PP) are predictors of poor cardiovascular disease outcomes. Low-level tragus stimulation (LLTS) is a noninvasive method to reduce sympathetic tone via vagal afferent fibers. It is unknown if LLTS has a favorable effect on elevated variability in CASP and PP in patients with acute decompensated heart failure (HF) (ADHF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Patients hospitalized for ADHF after initial stabilization (median 80 years, males 60%) were randomly assigned to active or sham group, and LLTS (20 Hz, 1 mA) was delivered using an ear clip attached to the tragus (active group) or the earlobe (sham group) for 1 hour daily over 5 days. The variability of PP and CASP was measured before and after each stimulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Each of SD, CV, and \u03b4 in PP, CASP, radial augmentation index (rAI), %PP variation (PPV), and PP\u2005\u00d7\u2005heart rate (HR) was significantly decreased after stimulation in the active group (n\u2005=\u20058) (all P\u2005&amp;lt;\u20050.05), while \u03b4 in CASP was significantly increased after stimulation in the sham group (n\u2005=\u20058) (P\u2005&amp;lt;\u20050.05). All the changes in SD, CV, and \u03b4 in PP, CASP, rAI, %PPV, and PP\u2005\u00d7\u2005HR before and after stimulation were also significantly different between active and sham groups (all P\u2005&amp;lt;\u20050.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>In this proof-of-concept study, LLTS led to a better hemodynamic profile, as evident in variability reduction in PP, CASP, and rAI. Further studies are warranted to study the long-term hemodynamic effects of LLTS on HF.<\/jats:p>\n                    <jats:p>Clinical trial registration: UMIN000044121.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajh\/hpaf164","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T11:33:12Z","timestamp":1756207992000},"page":"208-213","source":"Crossref","is-referenced-by-count":2,"title":["Central Pressure Variability After Low-Level Tragus Stimulation in Acute Decompensated Heart Failure"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3838-1369","authenticated-orcid":false,"given":"Michiaki","family":"Nagai","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Hiroshima Asa Medical Association Hospital , Hiroshima ,","place":["Japan"]},{"name":"Cardiovascular Section, Department of Medicine, University of Oklahoma Health Science Center , Oklahoma 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