Cardiovascular autonomic alterations in hospitalized patients with community-acquired pneumonia

Abstract

BackgroundAlterations of cardiac autonomic control (CAC) are associated with poor outcomes in patients with infectious and non-infectious diseases. No evaluation of CAC in patients with community-acquired pneumonia (CAP) has been performed so far. The aim of the study was to assess CAC in patients with CAP and evaluate the impact of its alterations on disease severity and clinical outcomes in a multicenter, prospective, observational study.MethodsConsecutive patients hospitalized for CAP were enrolled between 2011 and 2013 two university hospitals in Italy. CAC was assessed by linear spectral and non-linear symbolic analysis of heart rate variability. The presence of severe CAP was evaluated on hospital admission. The primary study outcome was time to clinical stability (TCS) during hospitalization.ResultsAmong the 75 patients enrolled (median age: 75 years; 57 % males), a significantly lower total variability and reduction of sympathetic rhythmical component with predominant respiratory modulation was detected in comparison to controls. Among CAP patients affected by a severe CAP on admission, CAC showed a lower sympathetic modulation and predominant parasympathetic oscillatory rhythm. At the multivariate analysis, variables independently correlated with a TCS >7 days were total power, as marker of total variability, [OR (95 % CI): 0.997 (0.994–1.000), p = 0.0454] and sympathetic modulation [OR (95 % CI): 0.964 (0.932–0.998), p = 0.0367].ConclusionsLoss of sympathetic rhythmical oscillation is associated with a more severe disease and worse early clinical outcome in hospitalized patients with CAP.Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-016-0414-8) contains supplementary material, which is available to authorized users.

Cardiac Autonomic Derangement Is Associated with Worse Neurological Outcome in the Very Early Phases of Ischemic Stroke

“…A similar autonomic profile represents a stiff system, which is less capable to adequately respond to external and internal stressors stimuli. In other acute clinical conditions, like community-acquired pneumonia [34], it has been shown that such an autonomic profile is associated with worse clinical conditions.…”

Sympatho–Vagal Dysfunction in Patients with End-Stage Lung Disease Awaiting Lung Transplantation

“…Patients with cardiac autonomic dysfunction present several associated lung diseases, such as chronic obstructive pulmonary disease (COPD) [6,7], pulmonary arterial hypertension (PAH) [17], and cystic fibrosis (CF) [18] compared to age-matched controls. Although global HRV is reduced in patients with several lung diseases compared to healthy controls, the sympatho-vagal balance may be different considering disease severity and respiratory function [5,6]. The results of the current Figure 3.…”

“…Although there is no direct relation with the degree of airway narrowing in cardiac autonomic modulation, chronic hypoxemia can increase cardiac vagal activity and depress the sympathetic modulation of COPD patients [7]. Recently, a similar cardiac autonomic profile was reported in patients with community-acquired pneumonia (CAP) [5]. The global contribution from cardiac autonomic control, represented by the total power index of HRV spectral analysis, was reduced in CAP patients in comparison with healthy controls.…”

“…When performing a symbolic analysis (Figure 2), a difference was found between the two groups: more severely affected patients had significantly lower levels of 0V% (20 ± 16 vs. 31 ± 15, p = 0.01) and higher levels of 2LV% (10 (7-18) vs. 5 (3)(4)(5)(6)(7)(8), p = 0.004).…”

“…A reduction of global HRV has been associated with poor prognosis in several cardiovascular diseases [4]. Although cardiac autonomic modulation seems impaired in pulmonary diseases [5][6][7], the interplay between cardiac autonomic modulation and severity of end-stage pulmonary disorders in patients waiting for LTx has not been studied yet.…”