Background/Purpose: Decreased heart rate variability (HRV) is a sign of potentially serious cardiac morbidity and is known to reflect autonomic dysfunction and inflammatory dysregulation (1). We have previously reported a cross-sectional association as well as association of changes between disease activity and HRV in patients with systemic lupus erythematosus (SLE) (2). We have not however yet demonstrated a predictable temporal relationship over time between SLE disease activity and HRV in individual patients.

Methods:  To prospectively test the hypothesis that clinical improvement is reflected by increased HRV, we designed an ongoing clinical trial to include HRV measurements using a 5 min ECG and HRV parameters calculated in the time domain (RMSSD and pNN50) and frequency domain [high frequency (HF) and the low frequency to high frequency (LF/HF) ratio]. Here we report findings from 32 SLE patients (31 female, age 46.2 +/- 10.9) who have completed a minimum of 2 visits to date. A mixed effects linear model was used to compare the change in HRV parameters between 83 paired visits. Two groups were compared, those with clinical improvement between visits (group 1) and those with same or worse disease activity (group 2). Clinical improvement was defined as >/= 1 letter grade improvement in BILAG between visits with no new BILAG A or B scores.

Results:  There was improvement in 14 (17%) of the paired, consecutive visits and no improvement or worsening in 69 (83%) visits. An inverse relationship was observed between clinical improvement and change in RMSSD, change in pNN50 and % change in HF (Table 1). The LF/HF ratio increased significantly between visits of patients in group 1 and decreased between visits in group 2 (4.51±1.95% vs. -0.14±0.83%, respectively; p=0.031).

Conclusion: HRV changes reflect changes in clinical status over time in patients with SLE. These data suggest that HRV may be a simple non-invasive tool for tracking clinical improvement and underscore the role of the autonomic nervous system in inflammatory pathways. Table 1.

References:

1. Tracey KJ. The inflammatory reflex. Nature. 2002;4206917:853-9.
2. Thanou A, Stavrakis S, Dyer J, Kamp S, Munroe ME, Albert D, James JA, Merrill JT. Heart Rate Variability Is Associated with SLE Flare and with TNF- and IFN-Mediated Signaling. American College of Rheumatology Annual Scientific Meeting. San Francisco, CA. November 7-11, 2015.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-heart-rate-variability-reflects-improvement-in-clinical-status-of-patients-with-systemic-lupus-erythematosus/