Asuman BİÇER, Ramazan AKDEMİR, Özlem Karakurt KARAKURT, Havva Kaya AKIŞ, Betül KARASU, Ünal GÜNTEKİN, Ali YILDIZ, Yusuf SEZEN, Recep DEMİRBAĞ, Fatma ESKİOĞLU

Psöriazisli hastalarda kalp hızı değişkenliği ve türbülans analizi

Amaç: Psöriasis Vulgaris (PV), çok sayıda sistemik hastalık insidansının arttığı gösterilen bir kronik yangısal deri hastalığıdır. Ancak PV\'in otonom sinir sistemi üzerine olan etkisi iyi tanımlanmamıştır. Artmış sempatik aktivite ile seyreden bozulmuş otonomik işlev bozukluğu, genel populasyonda ani kalp ölümü ve ventriküler aritmilerle ilişkilidir. Kalp Hızı Türbülansı (KHT), anormal barorefleks duyarlılığını ve artmış sempatik tonusu gösteren invaziv olmayan bir testtir. Bu çalışmanın amacı; artmış ventriküler aritmi ve ani kardiyak ölüm riskinin muhtemel göstergeleri olan KHT ve kalp hızı değişkenliği (KHD) parametrelerini kullanarak, PV\'nin kardiyak otonomik fonksiyon üzerine olan etkisini saptamaktır. Gereç ve yöntem: Çalışmaya kardiyovasküler tutulumu olmayan 20 psöriatik hasta ve yaş-cinsiyet yönünden benzer 20 sağlıklı birey dahil edildi. Hastalık ciddiyeti, âPsöriasis Alan Şiddet İndeksiâ kullanılarak değerlendirildi. KHD ve türbülans analizi, 24 saat-Holter kayıtları ile elde edildi. Bulgular: İki grup arasında, klinik, demografik ve biyokimyasal karakteristikler açısından istatistiksel anlamlı farklılık yoktu (p>0.05). KHT parametreleri karşılaştırıldığında, psöriatik hastalarda turbulans onset ve slop değerleri kontrol grubundan farklı değildi (p>0.05). Yüksek frekans gücü haricinde (psöriatik hastalarda daha düşük, p0.05). Sonuç: KHD ve KHT değerleri açısından, PV bozulmuş otonomik fonksiyon ile ilişkili gözükmemektedir. Bu sonuçları doğrulayacak daha ileri araştırmalar gereklidir.

Anahtar Kelimeler:

Kalp hızı değişkenliği, psöriazis, türbülans analizi

Heart rate variability and turbulence analysis in patients with psoriasis

Objectives: Psoriasis vulgaris (PV) is a chronic inflammatory skin disorder with increased incidence of many systemic abnormalities. However, the effects of psoriasis on autonomic nervous system have not been previously well-defined. Impaired autonomic function with an increase in sympathetic activity may be associated with ventricular arrhythmias and sudden cardiac death in the general population. Heart rate turbulence (HRT) is a noninvasive test to reflect the increased sympathetic tone and abnormal baroreflex sensitivity. The aim of current study was to investigate the effect of psoriasis on cardiac autonomic function by using HRT and heart rate variability (HRV) parameters as possible indicators of increased risk for ventricular arrhythmias and sudden cardiac death. Materials and methods: The study comprised 20 psoriatic patients without cardiovascular involvement and age and sex matched 20 healthy subjects. The severity of the disease was evaluated by the âPsoriasis Area and Severity Indexâ. The HRV and turbulence analysis were assessed from a 24-hour Holter recording. Results: There were no statistically significant differences between the two groups with respect to clinical, demographic and biochemical characteristics. When HRT parameters were compared; the values of the turbulence onset and slope in psoriatic patients were not significantly different from the control group (p>0.05). HRV parameters except for high frequency power (significantly lower in psoriatic patients, p0.05). Conclusion: Psoriasis appeared not to be associated with impaired autonomic function regarding to HRT and HRV values. Further investigations are needed to confirm these results.

Keywords:

Heart rate variability; psoriasis; turbulence analysis.,

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Gottlieb AB, Dann F. Comorbidities in patients with psoria- sis. Am J Med 2009;122:1150.e1-9.
Wakkee M, Thio HB, Prens EP, Sijbrands EJ, Neumann HA. Unfavorable cardiovascular risk profiles in untreated and treated psoriasis patients. Atherosclerosis 2007;190:1-9.
Gunes Y, Tuncer M, Calka O, et al. Increased frequency of pulmonary hypertension in psoriasis patients. Arch Derma- tol Res 2008;300:435-40.
Biyik I, Narin A, Bozok MA, Ergene O. Echocardiographic and clinical abnormalities in patients with psoriasis. J Int Med Res 2006;34:632-9.
Bicer A, Acikel S, Kilic H, et al. Impaired aortic elasticity in patients with psoriasis. Acta Cardiol 2009;64:597-602.
Vena GA, Vestita M, Cassano N. Psoriasis and cardiovascu- lar disease. Dermatol Ther 2010;23:144-51.
Ena P, Madeddu P, Glorioso N, Cerimele D, Rappelli A. High prevalence of cardiovascular diseases and enhanced activity of the renin-angiotensin system in psoriatic pa- tients. Acta Cardiol 1985;40:199-205.
Moya JL, Sanchez M, Morales MD, Brito E. Mitral valve prolapse (MVP) in psoriatic arthritis (PA). Arch Intern Med 1987;147:992-5.
Muna WF, Roller DH, Craft J, Shaw RK, Ross AM. Psoriatic arthritis and aortic regurgitation. JAMA 1980;244:363-5.
Kleiger RE, Stein PK, Bigger JT Jr. Heart Rate Variability: measurement and clinical utility. Ann Noninv Electrocar- diol 2005;10:88-101.
Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysi- ology. Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Circulation 1996;93:1043-65.
Schmidt G, Malik M, Barthel P, et al. Heart rate turbu- lence after ventricular premature beats as a predictor of mortality after acute myocardial infarction. Lancet 1999;353:1390-6.
Francis J, Watanabe MA, Schmidt G. Heart rate turbulence: a new predictor for risk of sudden cardiac death. Ann Non- inv Electrocardiol 2005;10:102-9.
Novikova DS, Korotaeva TV, Loginova EIu, et al. Clini- cal implication of assessment of heart rate variability in pa- tients with psoriatic arthritis. Ter Arkh 2009;81:47-52.
Markuszeski L, Bissinger A, Janusz I, Narbutt J, Jedrzejows- ka AS, Zalewska A. Heart rate and arrhythmia in patients with psoriasis vulgaris. Arch Med Res. 2007;38:64-9.
Feldman SR. A quantitative definition of severe psoriasis for use in clinical trials. J Dermatol Treat 2004;15:27-9.
Schmitt J, Wozel G. The psoriasis area and severity index is the adequte criterion to define severity in chronic plaque- type psoriasis. Dermatology 2005;210:179-181.
Finlay AY. Current severe psoriasis and the rule of tens. Br J Dermatol 2005;152:861-7.
Pincelli C, Fantini F, Magnoni C, Giannetti A. Psoriasis and the nervous system. Acta Derm Venereol Suppl (Stockh). 1994;186:60-1.
Pearce DJ, Morrison AE, Higgins KB, et al. The comorbid state of psoriasis patients in a university dermatology prac- tice. J Dermatol Treat 2005;16:319-23.
Inerot A, Enerback C, Enlund F, et al. Collecting a set of psoriasis family material through a patient organisation; clinical characterization and presence of additional disor- ders. BMC Dermatol 2005;14:5-10.
Choi JB, Hong S, Nelesen R, et al. Age and ethnicity differ- ences in short-term heart-rate variability. Psychosom Med 2006;68:421-6.
Jeron A, Kaiser T, Hengstenberg C, Lowel H, Riegger GA, Holmer S. Association of the heart rate turbulence with classic risk stratification parameters in postmyocardial in- farction patients. Ann Noninv Electrocardiol 2003;8:296- 301.
Gunduz H, Arinc H, Kayardi M, Akdemir R, Ozyildirim S, Uyan C. Heart rate turbulence and heart rate variability in patients with mitral valve prolapse. Europace 2006;8:515– 20.
Cygankiewicz I, Zareba W, Vazquez R, et al. Relation of heart rate turbulence to severity of heart failure. Am J Car- diol 2006;98:1635-40.
Sestito A, Valsecchi S, Infusino F, et al. Differences in heart rate turbulence between patients with coronary artery dis- ease and patients with ventricular arrhythmias but structur- ally normal hearts. Am J Cardiol 2004;93:1114-8.
Cagirci G, Cay S, Karakurt O, et al. Influence of heavy ciga- rette smoking on heart rate variability and heart rate turbu- lence parameters. Ann Noninv Electrocardiol 2009;14:327- 32.