Association of Cardiac Autonomic Responses with Clinical Outcomes of Myasthenia Gravis: Short-Term Analysis of the Heart-Rate and Blood Pressure Variability

Zawadka‐Kunikowska, Monika; Rzepiński, Łukasz; Tafil-Klawe, Małgorzata; Klawe, Jacek J.; Zalewski, Paweł; Słomko, Joanna

doi:10.3390/jcm11133697

Cited by 7 publications

(19 citation statements)

References 49 publications

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“…The on-call resident and the attending physician were consulted: Metoprolol was decreased from 50 to 25 mg daily; later, the PCP discontinued the med and referred Brian to cardiology (https://www. myaware.org/drugs-to-avoid; (Zawadka-Knuikowska et al, 2022). -Medication on healthcare record was not changed when the PCP increased glipizide from 20 to 40 mg daily.…”

Section: Key Practice Pointsmentioning

confidence: 99%

Medication Management in Patients with Polypharmacy

Miller

2023

Rehabilitation Nursing

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Section: Key Practice Pointsmentioning

confidence: 99%

Medication Management in Patients with Polypharmacy

Miller

2023

Rehabilitation Nursing

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“…Response to Tilt: LF tilt , HF tilt , LF/HF tilt , LF/HF tilt of HRV, PSD tilt Data pooled from two studies [10,11] including 68 subjects with MG and 60 HCs demonstrated that patients with MG had a lower HF-RRI during tilt (g = −0.75, 95% CI −0.11-−0.39, p < 0.001). There was no heterogeneity (I 2 = 0; p = 0.98).…”

Section: Frequency Domain Hrv Parameters Inmentioning

confidence: 99%

“…The concept of cardiac involvement in MG was presented for the first time in 1901 when Bramwell described a 30-year-old male myasthenic patient who had tachycardia and heart failure, and defined it as cardiomyasthenia [5]. Since then, research has described myositis and/or myocarditis, conduction and diastolic left ventricle abnormalities, and cardiac autonomic dysfunction (CAD) in MG [6][7][8][9][10][11][12][13][14][15][16][17]. CAD has remained poorly characterized, probably due to subclinical forms and the lack of routine cardiac autonomic evaluation in MG patients.…”

Section: Introductionmentioning

confidence: 99%

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Altered Cardiac Autonomic Regulation in Individuals with Myasthenia Gravis—A Systematic Review and Meta-Analysis

Zawadka-Kunikowska,

Rzepiński,

Tafil-Klawe

et al. 2023

Neurology International

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The aim of this systematic review with meta-analysis was to determine differences in cardiovascular autonomic parameters between patients with myasthenia gravis (MG) and healthy controls (HCs). Two reviewers searched four electronic databases, namely PubMed, Web of Science, EMBASE, and SCOPUS, from database inception to 7 July 2023 for studies investigating cardiovascular autonomic parameters in MG vs. HCs. A random-effects meta-analysis was performed to compute Hedges’ g ± 95% confidence intervals (CI). Out of a total of 2200 records, 8 observational studies with a sample size of 301 patients with MG and 454 HCs were included in the systematic review. Meta-analysis revealed lower values of expiration/inspiration ratio (g = −0.45, I2 = 74.7), baroreflex sensitivity (g = −0.56, 95%CI −0.80, −0.33; I2 = 0.3), percentage of adjacent NN intervals differing by more than 50 ms (g = −1.2, I2 = 82.8), square root of the mean of squared differences between successive beat intervals (g = −1.94, I2 = 95.1), mean of the standard deviations of all NN intervals (g = −0.83, 95%CI −1.37, −0.28; I2 = 55.5), and high frequency of HRV during tilt (g = −0.75, 95%CI −0.11, −0.39; I2 = 0). MG patients vs. HCs had higher systolic blood pressure (g = 0.39; I2 = 56.1), sympathovagal balance at rest/during tilt (LF/HF-RRIsupine, g = 0.44; I2 = 0; LF/HF-RRItilt, g = 0.86; I2 = 0; LF/HFtilt, g = 0.40; I2 = 0). As a group, MG patients have altered cardiac autonomic function, including decreased parasympathetic function, lower baroreflex sensitivity, and higher sympathovagal balance at rest and during orthostatic challenges.

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“…However, the cardiac dysfunction was also associated with MG. Dysfunction of the cardiac autonomic nervous system with predominant parasympathetic impairment might lead to abnormal baroreflex sensitivity, as well as heart-rate and blood-pressure variability [ 2 , 3 , 4 ]. Recently, myocardial injury was also reported in patients with MG [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Myocardial Injury in Hospitalized Patients with Myasthenia Gravis

Chen

Kong

Zhang

et al. 2022

JCM

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Objective: To investigate the clinical characteristics and outcome of myocardial injury in patients with myasthenia gravis (MG). Methods: We retrospectively searched medical records to screen hospitalized patients with MG at our hospital. The troponin T (TnT) levels were deemed necessary to be performed based on the patient’s clinical symptoms and were used as biomarkers of myocardial injury. The patients’ demographic and clinical information were collected. Death was the primary outcome. Results: A total of 336 patients with MG measured TnT levels and were included in the final analysis. The male MG patients with elevated TnT levels had a higher prevalence of infection (56.8% vs. 30.0%, p = 0.001) and myasthenic crisis (37.5% vs. 13.3%, p = 0.001) than those with normal TnT levels. Meanwhile, the female MG patients with elevated TnT levels were older (56.0 (16.6) vs. 49.2 (17.2)) years old, p = 0.007] and had a higher prevalence of infection (65.4% vs. 32.1%, p < 0.001), myasthenic crisis (33.6% vs. 17.9%, p = 0.015), and thymoma (38.5% vs. 16.7%, p = 0.001) than those with normal TnT levels. Older age (coef. = 0.004; p = 0.034), infection (coef. = 0.240; p = 0.001), myasthenic crisis (coef. = 0.312; p < 0.001), thymoma (coef. = 0.228; p = 0.001), and ICI therapy (coef. = 1.220; p < 0.001) were independent risk predictors for increasing log TnT levels. Thirty-seven patients died during hospitalization. High log TnT levels (OR = 8.818; p < 0.001), female sex (OR = 0.346; p = 0.023), thymoma (OR = 5.092; p = 0.002), and infection (OR = 14.597; p < 0.001) were independent risk predictors of death. Conclusions: Our study revealed that the surveillance of myocardial injury biomarkers in MG patients might be beneficial.

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Association of Cardiac Autonomic Responses with Clinical Outcomes of Myasthenia Gravis: Short-Term Analysis of the Heart-Rate and Blood Pressure Variability

Cited by 7 publications

References 49 publications

Medication Management in Patients with Polypharmacy

Medication Management in Patients with Polypharmacy

Altered Cardiac Autonomic Regulation in Individuals with Myasthenia Gravis—A Systematic Review and Meta-Analysis

Myocardial Injury in Hospitalized Patients with Myasthenia Gravis

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