Autonomic dysfunction and primary antiphospholipid syndrome: a frequent and frightening correlation?

Abstract

Introductionthe correlation between primary antiphospholipid syndrome (APS) and cardiovascular events is well known, but the correlation between APS and sudden death is not clear; it probably correlates with sympathetic alterations of the autonomic system.AimTo compare the autonomic nervous system (ANS) in a group of subjects suffering from APS against that of a control group with no cardiovascular risk factors, matched for age, sex, and body mass index.Subjects and methodsAn equal number (n = 31) of subjects with APS, and healthy controls, underwent autonomic evaluation: tilt test, deep breath, Valsalva maneuver, hand grip, lying-to-standing, Stroop, and sweat tests.ResultsCases in the APS group were positive for the tilt test, relating to changes in respiratory rate intervals, by comparison with controls. Results of other tests were also altered significantly in APS cases, by comparison with controls. (The sweat and Stroop tests were only performed in 14 cases). Autonomic disease did not correlate with age, sex, history of disease, arterial or venous thrombosis, or antibody positivity; only their coagulation parameters correlated with autonomic dysfunction.ConclusionAutonomic dysfunction in APS seems to correlate with coagulation parameters. APS patients should receive autonomic evaluation, to minimize the risks of fatal arrhythmias and sudden death.

Postural tachycardia syndrome (POTS) and other autonomic disorders in antiphospholipid (Hughes) syndrome (APS)

“…11,21 APS is also associated with an increased risk of cardiovascular disease and mortality. [1][2][3][4][5][6]13,14 The cardiac and neurological manifestations seen in APS occur because of both thrombotic and non-thrombotic mechanisms. The pathogenesis of the non-thrombotic manifestations seen in APS is complex and incompletely understood, but includes antibody-mediated activation of endothelial cells, platelets, monocytes, clotting factors and complement pathways.…”

“…11 Labile hypertension without associated renal disease and autonomic neuropathy were reported in early descriptions of the syndrome, 12 and a recent study by Bilora et al demonstrated abnormalities in cardiovascular autonomic function testing in APS patients without cardiovascular disease, cardiovascular risk factors or other autoimmune disorders. 13 Garcia et al also recently reported impaired aerobic exercise capacity and cardiac autonomic control in APS patients. 14 However, an association between APS and autonomic disorders, such as postural tachycardia syndrome (POTS), neurocardiogenic syncope (NCS) and neurogenic orthostatic hypotension (OH), has not previously been reported.…”

Carotid Atherosclerosis and Flow Mediated Dilatation in the Brachial Artery in Patients with Antiphospholipid Syndrome: A Case-control Study

“…All the patients gave oral informed consent. The same group was also submitted to the autonomic study for another research protocol already published [7].…”

Targeting the Autonomic Nervous System for Risk Stratification, Outcome Prediction and Neuromodulation in Ischemic Stroke

“…Unfortunately, literature about autonomic analysis in these subsets of patients is scarce. However, reduced HRV has been demonstrated in specific cohorts, such as treatment-naïve unselected cancer patients [ 60 ], and autonomic dysfunction in anti-phospholipid syndrome has been shown to closely correlate with thrombophilic state [ 61 ]. As for ANS function, both in vitro and in vivo studies have demonstrated that increased sympathetic activity may trigger a hypercoagulable state per se, either by platelet activation [ 62 ], or by local hemostatic activity increasing vascular resistance [ 63 ].…”