Session Information
Date: Monday, November 9, 2015
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Decreased heart rate variability (HRV), associated with adverse outcomes in cardiovascular diseases, is frequently seen in patients with SLE. The LF/HF ratio, a HRV measure, reflects sympathovagal balance. We examined associations of HRV with SLE activity and cytokine expression.
Methods: 53 SLE patients were evaluated at 2 visits (total 106 visits) with BILAG, SLEDAI, PGA and SFI (SELENA Flare Index). Caffeine, tobacco and medications were recorded. HRV (RMSSD, pNN50, HF, LF/HF ratio) was measured using a 5-minute ECG. Plasma cytokines were assessed by ELISA or a multiplex immunoassay.
Results: Baseline HRV was inversely related to disease activity and flare (table). Changes in HRV between visits were inversely related to changes in SLEDAI and PGA. Hydroxychloroquine dose was associated with increased HRV. Age, caffeine, tobacco and other medications had no impact. Plasma TNFRII and MIG inversely correlated with baseline HRV, and similar trends were observed for BLyS, IL-1α, IFNα and IP-10. Using multivariate linear regression model with backward elimination, TNFRII was an independent predictor of baseline HRV after adjusting for hydroxychloroquine dose and plasma BLyS, IL-1α and IFNα. In a similar model, MIG impact remained significant adjusting for the same variables. Furthermore, changes in the LF/HF ratio between visits were associated with changes in TNFRII (p=0.048) and MIG (p=0.029).
Conclusion: Impaired HRV, particularly the LF/HF ratio, is associated with lupus disease activity, acute flare state, and several cytokines related to TNF and IFN pathways. The strongest association was with TNFRII and MIG, confirming and expanding previous immune connections to vagal signaling.
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p values |
Univariate linear regression |
Multivariate linear regression |
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Dependent variables at baseline |
Dependent variables at baseline |
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RMSSD |
pNN50 |
HF |
LF/HF |
RMSSD |
pNN50 |
HF |
LF/HF |
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Independent variables at Baseline |
BILAG |
0.259 |
0.019 |
0.02 |
0.024 |
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|
|
|
|
SLEDAI |
0.683 |
0.312 |
0.488 |
0.073 |
|
|
|
|
|
|
PGA |
0.651 |
0.014 |
0.154 |
0.062 |
|
|
|
|
|
|
Flare (SFI) |
0.456 |
0.329 |
0.047 |
0.008 |
ns |
ns |
ns |
ns |
|
|
BLyS |
0.778 |
0.29 |
0.115 |
0.071 |
ns |
ns |
ns |
ns |
|
|
IL-17A |
0.689 |
0.132 |
0.174 |
0.988 |
|
|
|
|
|
|
TNFα |
0.361 |
0.533 |
0.354 |
0.903 |
|
|
|
|
|
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TNFRII |
<0.001 |
0.01 |
0.039 |
0.024 |
<0.001 |
0.01 |
0.039 |
0.024 |
|
|
IL-1α |
0.089 |
0.099 |
0.254 |
0.485 |
ns |
ns |
ns |
ns |
|
|
IFNα |
0.420 |
0.076 |
0.272 |
0.124 |
ns |
ns |
ns |
ns |
|
|
MIG |
0.007 |
0.015 |
0.018 |
0.026 |
0.007 |
0.015 |
0.018 |
0.026 |
|
|
IP-10 |
0.202 |
0.088 |
0.122 |
0.189 |
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To cite this abstract in AMA style:
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 [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/heart-rate-variability-is-associated-with-sle-flare-and-with-tnf-and-ifn-mediated-signaling/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/heart-rate-variability-is-associated-with-sle-flare-and-with-tnf-and-ifn-mediated-signaling/