Heart rate turbulence assessment in systemic sclerosis: the role for the detection of cardiac autonomic nervous system dysfunction

• Published in: Rheumatology (Oxford, England) Vol. 49; no. 2; pp. 355 - 360
• Main Authors: Bienias, Piotr, Ciurzyński, Michał, Glińska-Wielochowska, Maria, Szewczyk, Agnieszka, Korczak, Dariusz, Kalińska-Bienias, Agnieszka, Gliński, Wiesław, Pruszczyk, Piotr
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.02.2010
• Subjects: Adult; Aged; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - physiopathology; Autonomic Nervous System Diseases - diagnosis; Autonomic Nervous System Diseases - etiology; Autonomic Nervous System Diseases - physiopathology; Biological and medical sciences; Cardiac autonomic dysfunction; Case-Control Studies; Diseases of the osteoarticular system; Electrocardiography, Ambulatory - methods; Female; Heart - innervation; Heart Rate - physiology; Heart rate turbulence; Heart rate variability; Humans; Male; Medical sciences; Middle Aged; Prospective Studies; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Scleroderma, Systemic - complications; Scleroderma, Systemic - physiopathology; Systemic sclerosis; Cardiac autonomic dysfunction; Heart rate turbulence; Heart rate variability; Systemic sclerosis; Heart; Immunopathology; Connective tissue disease; Skin disease; Variability; Rheumatology; Autoimmune disease; Heart rate; Autonomic nervous system; Dysfunction; Systemic disease; Scleroderma
• ISSN: 1462-0324; 1462-0332; 1462-0332
• DOI: 10.1093/rheumatology/kep394

Objective. To assess the heart rate turbulence (HRT) in patients with SSc as a method of assessment for cardiac autonomic nervous function. Methods. We prospectively studied 68 consecutive patients with SSc before inclusion in the study. After a detailed clinical evaluation, including echocardiography, 45 subjects [aged 54.6 (14.7) years; 40 women] underwent 24-h Holter monitoring for HRT and time- and frequency-domain heart rate variability (HRV) assessment. Results were compared with those in 30 age- and sex-matched healthy controls. Results. As compared with controls, HRT was impaired in SSc patients: the median turbulence onset (TO) was higher (P = 0.0001) and the median turbulence slope (TS) was lower (P = 0.0003). Abnormal HRT (TO ⩾0.0% and/or TS ⩽2.5 ms/RR) was found in 42% of SSc patients. Moreover, SSc duration correlated negatively with values of TS (r = −0.3; P = 0.045). HRT did not differ between diffuse and limited SSc groups. All estimated time- and the majority of frequency-domain values of HRV parameters in SSc were significantly lower than in controls. Significant correlations were also demonstrated between HRT and HRV parameters. Conclusions. HRT, like HRV assessment, indicates a frequent impairment of the cardiac autonomic nervous system in SSc patients, irrespective of the SSc type.