The degree of cardiac baroreflex involvement during active standing is associated with the quality of life in fibromyalgia patients

Abstract

Fibromyalgia syndrome (FMS) is a rheumatologic disorder characterized by chronic widespread pain, fatigue and other symptoms. Baroreflex dysfunction has been observed in women with FMS. However, it is unknown whether the limited involvement of the baroreflex control during an orthostatic stimulus has some impact on the quality of life of the FMS patient. Therefore, the aim of the study is evaluate the relationship between the quality of life of the FMS patient and indexes of the cardiovascular autonomic control as estimated from spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP). We enrolled 35 women with FMS (age: 48.8±8.9 years; body mass index: 29.3±4.3 Kg/m2). The electrocardiogram, non-invasive finger blood pressure and respiratory activity were continuously recorded during 15 minutes at rest in supine position (REST) and in orthostatic position during active standing (STAND). Traditional cardiovascular autonomic control markers were assessed along with a Granger causality index assessing the strength of the causal relation from SAP to HP (CRSAP→HP) and measuring the degree of involvement of the cardiac baroreflex. The impact of FMS on quality of life was quantified by the fibromyalgia impact questionnaire (FIQ) and visual analog score for pain (VAS pain). No significant linear association was found between FIQ scores and the traditional cardiovascular indexes both at REST and during STAND (p>0.05). However, a negative relationship between CRSAP→HP during STAND and FIQ score was found (r = -0.56, p<0.01). Similar results were found with VAS pain. In conclusion, the lower the degree of cardiac baroreflex involvement during STAND in women with FMS, the higher the impact of FMS on the quality of life, thus suggesting that Granger causality analysis might be clinically helpful in assessing the state of the FMS patient.

The cardiac, vasomotor, and myocardial branches of the baroreflex in fibromyalgia: Associations with pain, affective impairments, sleep problems, and fatigue

“…These findings corroborate previous reports of negative correlations between cardiac BRS and state and trait anxiety (Watkins et al., 1999, 1998). They are also in line with observations of associations between BRS and current pain intensity (Zamunér, Barbic, et al., 2015) and quality of life (Zamunér et al., 2017) in FMS. In addition, lower cardiac BRS was observed in patients with depression and anxiety disorders (Broadley et al., 2005; Davydov et al., 2007; Hughes et al., 2006; Johansson et al., 2010; Watkins & Grossman, 1999).…”

The interplay between heated environment and active standing test on cardiovascular autonomic control in healthy individuals

“…Given the clinical relevance, HRV and blood pressure variability (BPV) have been associated with a high risk of mortality by cardiovascular disease (Tsuji et al 1996, Malliani andMontano 2002). In addition, the active standing test is a low-cost and real-life useful maneuver to investigate cardiovascular autonomic control in several populations (Moura-Tonello et al 2014, Zamunér et al 2017, Rodrigues et al 2019, Tobaldini et al 2020. A previous study has considered that cardiac autonomic adjustments to active standing test and nonlinear HRV tool added new information to resting parameters and linear analysis, respectively (Rodrigues et al 2019, Tobaldini et al 2020.…”

Blood pressure in women presenting fibromyalgia as a function of pain and avoidance disparities.

“…Several of the symptoms expressed in FM seem associated with 'dysautonomia', e.g. the widespread pain, insomnia, irritable bowel, etc., which has prompted analyses of spontaneous fluctuations of the heart period and systolic pressure featuring elevated sympathetic control, reduced vagal modulation and lower cardiac baroreflex sensitivity [23,24] several of these expressions implicate decreases/ dysregulation of parasympathetic activation and loss of heart rate variability [25].…”