Figen Ceylan ÇEVİK, Selma YAZICI, Ali Fuat KARA, Zuhal ATILGAN, Habib ÇİL, Ebru TEKBAŞ, REMZİ ÇEVİK, Mehmet TAHTASIZ, A. Jale SARAÇ

Romatoid artritli hastalarda kardiyak sempatovagal aktivitenin kalp hızı değişkenliği ile değerlendirilmesi

Amaç: Romatoid artritte (RA) inflamatuar strese bağlı sempatik sinir sistemi aktivitesinde artış ve buna bağlı kalp hızı değişkenliğinde bozulma olduğu bildirilmiştir. Bu çalışmada RA’lı hastalarda kalp hızı değişkenliği (KHD) gibi noninvaziv elektrofizyolojik parametreler aracılığıyla kardiyak sempatovagal aktivite değerlendirildi. Gereç ve yöntem: Bu çalışmaya 49 RA’lı hasta ve benzer yaşta 28 sağlıklı birey kontrol grubu olarak alındı. Tüm bireylerin klinik ve laboratuar parametreleri değerlendirildi ve hepsine 24 saatlik Holter elektrokardiografik monitorizasyon yapıldı. Bulgular: Hasta grubunda minimal, maksimal ve ortalama kalp hızları kontrol grubuna kıyasla oldukça anlamlı düzeyde yüksek ve ortalama RR intervali de anlamlı düzeyde düşük bulundu. Ek olarak, zaman bağımlı KHD parametreleri arasında SDNN, SDANN ve triangular indeks anlamlı düzeyde düşük saptandı. (sırasıyla p

The assessment of cardiac sempathovagal activity by heart rate variability in patients with Rheumatoid Arthritis

Objectives: It has been reported that increased sempathic nerve system activity due to infalammatory stress and it cause disturbance of heart rate variability (HRV) in rheumatoid arthritis (RA). In this study, it was assessed cardiac sempatovagal activity by noninvasive parameters such as HRV in patients with RA. Materials and methods: 49 patients with RA and age-matched 28 healthy subjects as control group were enrolled to this study. Clinical and laboratory parameters of all subjects were assessed and 24-hour electrocardiographic Holter monitoring were performed to all of them. Results: Minimum, maximum and mean heart rate were significantly higher while mean RR interval were significantly lower in patients with RA when compared with controls. In addition, among time domain HRV parameters, SDNN, SDANN ve triangular index were significantly lower in patients with RA (p<0.05, p<0.01, p<0.01, respectively). In correlation analysis, it was not found a significant association between HRV parameters and age, sex, duration and activity of disease, inflammatory markers, supraventricular or ventricular extrasystole (VES). There were only significant negative associations between VES and pNN50, SDANN and RMSDD. But, there was no independent correlation between these parameters. Conclusion: Non-invasive parameters such as HRV may have a modest role in assessment of cardiovascular risk and prediction of sudden cardiac death risk, in addition to the traditional risk factors, in patients with RA. However, to reach to the more accurate decision, there are need to carry out larger and long term studies which include different patients groups

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1. Wallberg Jonsson S, Ohman Ml. Cardiovascular morbidity and mortality in patients with seropositive Rheumatoid arthritis. J Rheumatol 1997; 24: 445-51.
2. Riise T, Jacopsen BK, Gran JT Haga HJ, Arnesen E. Total mortality is increased in rheumatoid arthritis. A 17-year prospective study. Clin Rheumatol 2001; 20:123–7.
3. Myllykangas-Luosujärvi R, Aho K, Kautiainen H, Isomäki H. Cardiovascular mortality in women with rheumatoid arthritis. J Rheumatol 1995;22:1065-7.
4. Mandell BF, Hoffman GS. Rheumatic Diseases and the Cardiovascular System. In: Zipes DP, Libby P, Bonow RO, Braunwald E (Eds.). Braunwald’s Heart Disease, a textbook of Cardiovascular Medicine. 7th ed. Philadelphia: Elsevier Saunders; 2005. p. 2101-16.
5. Maradit-Kremers H, Crowson CS, Nicola PJ et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum 2005; 52: 402–11.
6. Stein PK, Bosner MS, Kleiger RE, Conger BM. Heart rate variability: a measure of cardiac autonomic tone. Am Heart J 1994:127:420–4.
7. Ewing DJ, Campbell IW, Clarke BF. The natural history of diabetic autonomic neuropathy. Q J Med 1980: 193:95–108.
8. Kleiger RE, Miller JP et al. Multicentre post infarction research group, Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 1987; 59 :256–262
9. Malliani A, Lombardi F, Pagani F et al. Power spectral analysis of cardiovascular variability in patients at risk for sudden cardiac death. J Cardiovasc Electrophysiol 1994: 5:274–86.
10. Pumprla J, Howarka K, Groves D et al. Functional assessment of heart rate variability: physiological basis and practical applications. Int J Cardiol 2002: 84:1–14.
11. Kao T, Hsiao HC, Chiu HW et al. The relationship of late potentials to assessment of heart rate variability in post-infarction patients. Int J Cardiol 2000:74:207–14.
12. Nolan J, Batin PD, Andrews R, Lindsay SJ et al. Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom Heart Failure Evaluation and Assessment of Risk Trial (UKHEART). Circulation 1998: 98:1510–6.
13. O’Brien IA, McFadden JP, Corrall RJM. The influence of autonomic neuropathy on mortality in insulin-dependent diabetes. Q J Med 1991:79:495–502.
14. Malpas SC, Gordon LP. Circadian variation of heart rate variability. Cardiovasc Res 1990:24:210-213
15. Malik M. Heart rate variability. Curr Opinion Cardiology 1998; 13: 36-44.
16. Louthrenoo W, Ruttanaumpawan P, Aramrattana A, Sukitawut W. Cardiovascular autonomic nervous system dysfunction in patients with rheumatoid arthritis and systemic lupus erythematosus. QJM 1999: 92:97–102
17. Maule S, Quadri R, Mirante D et al. Autonomic nervous dysfunction in systemic lupus erythematosus and rheumatoid arthritis: possible pathogenic role of autoantibodies to autonomic nervous structures. Clin Exp Immunol 1997:110:423–7.
18. Evrengul H, Dursunoglu D, Cobankara V et al. Heart rate variability in patients with rheumatoid arthritis. Rheumatol Int 2004;24:198–202.
19. Anichkov DA, Shostak NA, Ivanov DS. Heart rate variability is related to disease activity and smoking in rheumatoid arthritis patients. Int J Clin Pract, 2007, 61: 777–83.
20. Arnett FC, Edwothy SM, Bloch DA, et al. The American Rheumatism Association 1987 criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315–24.
21. Henry WL, DeMaria A, Gramiak R, et al. Report of the American society of echocardiography committee on nomenclature and standards in two dimensional imaging. Circulation 1980; 62: 212–7.
22. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation 1996; 93: 1043-65.
23. Ferri C, Emdin M, Giuggioli D et al. Autonomic dysfunction in systemic sclerosis: time and frequency domain 24 hour heart rate variability analysis. Br J Rheumatol 1997; 36: 669–676
24. Laversuch CJ, Seo H, Modarres H, Collins DA, McKenna W, Bourke BE. Reduction of heart rate variability in patients with systemic lupus erythematosus. J Rheumatol 1997: 24: 1540 -4.
25. Lombardi F. Clinical implications of present physiological understanding of HRV components. Card Electrophysiol Rev 2002; 6: 245-9.
26. Czura CJ, Tracey KJ. Autonomic neural regulation of immunity. J Intern Med 2005; 257: 156-66.
27. Sajadieh A, Nielsen OW, Rasmussen V, Hein HO, Abedini S, Hansen JF. Increased heart rate and reduced heart-rate variability are associated with subclinical inflammation in middle-aged and elderly subjects with no apparent heart disease. Eur Heart J 2004; 25: 363–70.
28. Janszky I, Ericson M, Lekander M et al. Inflammatory markers and heart rate variability in women with coronary heart disease. J Intern Med 2004; 256: 421–8.
29. Dekkers JC, Geenen R, Godaert GL, Bijlsma JW, van Doornen LJ. Elevated sympathetic nervous system activity in patients with recently diagnosed rheumatoid arthritis with active disease. Clin Exp Rheumatol 2004; 22: 63 -70.
30. Straub RH, Harle P. Sympathetic neurotransmitters in joint inflammation. Rheum Dis Clin North Am 2005; 31: 43–59.
31. Umetani K, Singer DH, McCraty R, Atkinson M. Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades. J Am Coll Cardiol 1998; 31: 593-601
32. Antelmi I, de Paula RS, Shinzato AR, Peres CA, Mansur AJ, Grupi CJ. Influence of age, gender, body mass index, and functional capacity on heart rate variability in a cohort of subjects without heart disease. Am J Cardiol 2004;93:381-5.
33. Stein PK, Kleiger RE, Rottman JN. Differing effect of age on heart rate variability in men and women. Am J Cardiol 1997; 80: 302–5.
34. Sandhu V, Allen SC. The effects of age, seropositivity and disease duration on autonomic cardiovascular reflexes in patients with rheumatoid arthritis. Int J Clin Pract 2004; 58: 740–5.
35. Dessein PH, Joffe BI. When is a patient with rheumatoid arthritis at risk for cardiovascular disease? J Rheumatol 2006; 33: 201–3.
36. Sattar N, McCarey DW, Capell H, McInnes IB. Explaining how ‘high-grade’ systemic inflammation accelerates vascular risk in rheumatoid arthritis. Circulation 2003; 108: 2957–63.
37. Vaudo G, Marchesi S, Gerli R et al. Endothelial dysfunction in young patients with rheumatoid arthritis and low disease activity. Ann Rheum Dis 2004; 63: 31–5.
38. Hall FC, Dalbeth N. Disease modification and cardiovascular risk reduction: two sides of the same coin? Rheumatology (Oxford) 2005; 44: 1473–82.
39. Lombardi F. Sympathetic activation and sub-clinical inflammation: a new combination to identify high-risk subjects. Eur Heart J 2004; 25: 359–60.
40. Shehab AM, MacFadyen RJ, McLaren M, Tavendale R, Belch JJ, Struthers AD. Sudden unexpected death in heart failure may be preceded by short term, intraindividual increases in inflammation and in autonomic dysfunction: a pilot study. Heart 2004; 90: 1263–8.