ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 801

Cardiac Autonomic Modulation at Rest and during Orthostatic Stress in Systemic Sclerosis Patients

Adriana Severino1, Gabriel Dias Rodrigues2, Chiara Bellocchi1, Eleonora Tobaldini3,4, Nicola Montano3,4 and Lorenzo Beretta1, 1Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy, 2Department of Physiology and Pharmacology, Biomedical Institute, Fluminense Federal University, Niterói, Brazil, 3Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy, 4Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords:

Session Information

Date: Sunday, October 21, 2018

Title: Systemic Sclerosis and Related Disorders – Clinical Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Autonomic dysfunction is a marker of myocardial involvement in systemic sclerosis (SSc) and heart rate variability (HRV) is impaired in SSc patients (1). The aim of the present study was to investigate autonomic HRV both at rest and during active standing in very early (EaSSc), limited (lcSSc) and diffuse cutaneous (dcSSc) patients.

Methods: Sixty-nine SSc patients (18M/51F, mean age 58 ± 12 yrs) and 36 age-matched healthy controls (HC) (13M/23F, age 57 ± 12 yrs) underwent recording of ECG and respiration in supine and orthostatic position. Spectral analysis of HRV identified different oscillatory components: total power (TP), index of global autonomic variability, low frequency (LF), marker of sympathetic modulation, and high frequency (HF), marker of vagal modulation. LF/HF was calculated as index of sympatho-vagal balance. Unpaired t-test and ANOVA were used to compare HRV parameters between the groups.

Results: Our case series included 12 EaSSc, 39 lcSSc and 18 dcSSc, aged 54±8, 59±12 and 58±12 yrs with a prevalence of anti-Topo-I/anticentromere antibodies equal to and 8/67%, 28/54% and 44/11%, respectively. SSc patients had a predominant sympathetic modulation and lower vagal control compared to HC at rest (low HF and high LF and LF/HF, Table 1). In SSc subgroups analysis in which parameters of HRV both at rest and in response to orthostatic stress (DORT%), were significantly different in diffuse cutaneous (dcSSc) and limited cutaneous (lcSSc) patients compared to HC (Table 2). 

Conclusion: SSc patients have a decreased vagal and an increased sympathetic modulation at rest as well as a blunted autonomic response to orthostatic challenge. These alterations were present in definite forms of SSc but not in EaSSc, suggesting that autonomic dysfunction follows the development of fibrosis.  Further studies are needed to better establish the relationship between myocardial fibrosis and autonomic disfunction.

 

Table 1. Comparison of HRV indexes at rest between SSc and age-matched healthy control group. 

 

SSc

HC

p-value

Spectral analysis

 

 

 

Total power (ms2)

933±1107*

1769±1973

<0.01

LFn (n.u)

57±22. *

38±22

<0.001

HFn (n.u)

34±19*

57 ±21

<0.001

LF/HF

3.27 ±4.23*

1.12 ±1.60

<0.001

 

 

 

 

HFun: high frequency normalized unity; LFun: low frequency normalized unity

 

. 

Table 2. HRV indexes at rest and HRV adjustments from orthostatic stress between SSc sub-types and age-matched HC

 

DcSSc

LcSSc

EaSSc

HC

p-value

Spectral analysis

 

 

 

 

 

 

 

 

 

 

 

Total power (ms2)

 

 

 

 

 

SUP

439±248

1553 ±2858

1430±1173*

1769 ±1973*

0.04

DORT%

0.08 ±0.68

0.38 ±1.35

0.31 ±1.23

0.82 ±3.40

0.97

 

 

 

 

 

 

LFn (n.u)

 

 

 

 

 

SUP

61±20

58 ±22

54 ±25

38 ±22*.#

<0.01

DORT%

0.18 ±0.98

-0.07 ±0.48

0.45 ±0.92

1.42 ±2.09*.#

<0.001

 

 

 

 

 

 

HFn (n.u)

 

 

 

 

 

SUP

34 ±18

32 ±16

42 ±25

57 ±21*.#

<0.001

DORT%

-0.05 ±0.63

0.01 ±0.69

0.35 ±1.84

-0.40 ±0.51

0.09

 

 

 

 

 

 

LF/HF

 

 

 

 

 

SUP

3.01 ±3.02

3.20 ±3.40

3.74 ±5.81

1.12 ±1.60*.#

<0.001

DORT%

0.93 ±2.71

1.22 ±3.85

4.54 ±8.85

9.08 ±13.92*.#

<0.01

 

SUP: supine position; ORT: Orthostatic position HFun: high frequency normalized unity; LFun: low frequency normalized unity; DORT%: (HRV in SUP position – HRV in ORT position) / HRV in SUP position); ANOVA one-way for independent measures and Tukey post-hoc test; *differences from DcSSc, #differences from LcSSc, $differences from EaSSc. α<0.05.

 

1. Cozzolino D et al. Rheumatology (Oxford) 2002; 41: 586–8.

 

Disclosure: A. Severino, None; G. Dias Rodrigues, None; C. Bellocchi, None; E. Tobaldini, None; N. Montano, None; L. Beretta, EFPIA, 2.

To cite this abstract in AMA style:

Severino A, Dias Rodrigues G, Bellocchi C, Tobaldini E, Montano N, Beretta L. Cardiac Autonomic Modulation at Rest and during Orthostatic Stress in Systemic Sclerosis Patients [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/cardiac-autonomic-modulation-at-rest-and-during-orthostatic-stress-in-systemic-sclerosis-patients/. Accessed .

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