Autonomic nervous system dysfunction in sclerodermic and primary Raynaud's phenomenon

Abstract

Our aim was to investigate the sympathetic hyperactivity of systemic sclerosis that may lead to greater morbidity and mortality from cardiovascular events. We analysed the sympathetic (low-frequency) and vagal (high-frequency) components of heart rate variability, in supine and upright positions, in 10 patients with systemic sclerosis, 12 patients with primary Raynaud's phenomenon and 14 controls. We also analysed lung function in order to evaluate a possible link between heart rate variability and ventilation parameters. Heart rate variability was reduced in the supine position in subjects with systemic sclerosis both in comparison with primary Raynaud's phenomenon (total power: 1103+/-156 versus 3302+/-486 ms2, P<0.004) and control subjects (3148+/-422 ms2, P<0.002). Low-frequency power was higher in patients with systemic sclerosis than in the controls (54.5+/-4.5 versus 42.5+/-3.5 normalized units, P<0.01). During tilt, the change in heart rate was +44% in controls, +24% in subjects with primary Raynaud's phenomenon, and only +17% in the patients with systemic sclerosis (P<0.01 versus controls). In patients with systemic sclerosis we found a significant correlation between high-frequency power and the indices of lung function (residual volume: r2=0.5143, P<0.01; total lung capacity: r2=0.5142, P<0.01, vital capacity: r2=0.3789, P<0.05). Heart rate variability was reduced and sympathetic output increased in patients with systemic sclerosis. Subjects with primary Raynaud's phenomenon were characterized by normal heart rate variability and by some degree of sympathetic hyperactivity. During tilting, subjects with systemic sclerosis maintained an unmodified heart rate variability, thus suggesting an impaired baroceptor modulation of the autonomic control. The negative correlation between high-frequency power and indices of respiratory insufficiency in patients with systemic sclerosis suggests that the pulmonary structure plays an important role in the modulation of heart rate variability.

Autonomic Dysfunction Predicts Early Cardiac Affection in Patients with Systemic Sclerosis

“…In addition, Pancera et al40 found that HRV was reduced in patients with SSc in comparison to control subjects. On the contrary, Morelli et al41 analyzed HRV in the time domain and showed no significant difference in any variable between SSc patients and the controls.…”

Myocardial Damages in Systemic Sclerosis Detected by Gated Myocardial Perfusion SPECT and Sympathetic Imaging

“…Both sympathetic and parasympathetic dysfunction have been observed. 26 HR variability is reduced and sympathetic output increased in patients with SSc, 27 so a MIBG abnormality and rapid MIBG turnover may reflect sympathetic derangement in SSc. Gürtner et al reported that 123 I MIBG scintigraphy revealed an inhomogeneous reduction in 15 patients (83%).…”

Prolongation of the corrected QT interval in adult patients with anti‐Ro/SSA–positive connective tissue diseases

“…Several studies have shown the presence of cardiac autonomic dysfunction in Sjögren's syndrome patients, particularly in those with anti-Ro/SSA autoantibodies (6). Autonomic dysfunction has also been observed in other anti-Ro/SSA-positive connective tissue diseases, such as systemic lupus erythematosus and systemic sclerosis (7,8). These observations suggest that anti-Ro/SSA autoantibodies may determine a dysfunction in cardiac autonomic activity.…”