Akciğer Tutulumu Olan Sarkoidozun Kardiyak Otonom Disfonksiyon Üzerine Etkisi

Amaç: Kalp hızı değişkenliği (KHD), kardiyak otonom fonksiyonun değerlendirilmesinde kullanılan non-invaziv bir yöntemdir. Çalışmamızda akciğer tutulumu olan sarkoidoz hastalarında KHD ölçüm sonuçları değerlendirilerek, kardiyak otonom fonksiyon üzerine etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya 18 akciğer tutulumlu sarkoidoz hastası ile yaş ve cinsiyet uyumlu 18 sağlıklı gönüllü bireyden oluşan kontrol grubu olmak üzere toplamda 36 kişi dahil edildi. Tüm hastalara transtorasik ekokardiyografi, elektrokardiyografi (EKG) ve 24-saat EKG Holter uygulandı. Holterde saptanan KHD parametreleri kullanılarak gruplar karşılaştırıldı. Bulgular: Zaman alan analizinde RMSDD ölçüm değerleri ve frekans alan analizinde düşük frekans değerleri sarkoidoz grubunda kontrol grubuna kıyasla anlamlı ölçüde düşük bulundu (p=0,043 ve p=0,045). Ayrıca korelasyon analizinde, PR süresi ile zaman alan parametrelerinden SDNN ve SDANN, frekans alan parametrelerinden yüksek frekans arasında istatistiksel olarak anlamlı negatif bir korelasyon saptandı (p=0,009, p=0,003, p=0,047 sırasıyla). Düşük frekans/yüksek frekans oranı, düzeltilmiş QT süresi ile pozitif korelasyon gösterdi. Sonuç: Akciğer tutulumlu sarkoidoz hastalarında KHD parametrelerinde saptanan değişiklikler, azalmış parasempatik tonus ve vagal düzenlemeye bozulmuş kardiyak yanıt ile ilişkili olup, bu durum kardiyak aritmilere yatkınlık, ani kardiyak ölüm ve atriyoventiküler iletim bozukluğuna sebep olabilir.

The Effect of Pulmonary Sarcoidosis on Cardiac Autonomic Dysfunction

Aim: The assessment of heart rate variability (HRV) has been considered as an important non-invasive method to evaluate cardiac autonomic function. Concerning recent evidence on the relationship between impaired autonomic dysfunction and sarcoidosis, we aimed to investigate the effect of pulmonary sarcoidosis on cardiac autonomic dysfunction. Materials and Methods: This prospective study comprised of 36 participants, including 18 patients diagnosed with pulmonary sarcoidosis and 18 age-matched healthy volunteers. All participants underwent echocardiographic examination, 12-channel electrocardiography and 24-h Holter monitoring. HRV parameters were determined and compared between the groups. Results: In time domain analyses, RMSDD values significantly decreased in the patient group compared to the control group (p=0.043). The low-frequency power in frequency domain analyses between sarcoidosis patients and controls demonstrated a statistically significant difference (p=0.045). In the correlation analysis, PR duration was negatively correlated with all-time domain and frequency domain parameters as SDNN, SDANN and high-frequency values, which had a statistically significant difference (p=0.009, p=0.003, p=0.047 respectively). Corrected QT (QTc) duration was negatively correlated with all-time domain and frequency domain parameters as well. The low-frequency/high-frequency ratio was positively correlated with QTc duration.Conclusion: The patients with pulmonary sarcoidosis displayed a decrease in all HRV values reflecting diminished parasympathetic tone or blunted cardiac response to vagal modulation. This may cause cardiac outcomes such as atrioventricular conduction abnormalities, proarrhythmic tendency, ventricular arrhythmias and sudden death.

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1. Ogedengbe JO, Adelaiye AB, Kolawole OV. Effects of exercise on PR intervals, QRS durations and QTC intervals in male and female students of University of Abuja. J Pak Med Assoc. 2012;62:273-5.
2. Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med. 2007;357:2153-65.
3. Gilotra N, Okada D, Sharma A, Chrispin J. Management of Cardiac Sarcoidosis in 2020. Arrhythm Electrophysiol Rev. 2020;9:182-8.
4. McCraty R, Shaffer F. Heart Rate Variability: New Perspectives on Physiological Mechanisms, Assessment of Self-regulatory Capacity, and Health risk. Glob Adv Health Med. 2015;4:46-61.
5. Hainsworth R. Physiology of the Cardiac Autonomic System, in Clinical Guide to Cardiac Autonomic Tests, M. Malik (eds). Dordrecht: Springer; 1998:p.3-28.
6. Vinik AI, Casellini C, Parson HK, Colberg SR, Nevoret ML. Cardiac Autonomic Neuropathy in Diabetes: A Predictor of Cardiometabolic Events. Front Neurosci. 2018;12:591.
7. Nolan J, Batin PD, Andrews R, Lindsay SJ, Brooksby P, Mullen M, 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 (UK-heart). Circulation. 1998;98:1510-6.
8. Huikuri HV, Stein PK. Clinical application of heart rate variability after acute myocardial infarction. Front Physiol. 2012;3:41.
9. Ferri C, Emdin M, Giuggioli D, Carpeggiani C, Maielli M, Varga A, et al. Autonomic dysfunction in systemic sclerosis: time and frequency domain 24 hour heart rate variability analysis. Br J Rheumatol. 1997;36:669-76.
10. Lombardi F, Mäkikallio TH, Myerburg RJ, Huikuri HV. Sudden cardiac death: role of heart rate variability to identify patients at risk. Cardiovasc Res. 2001;50:210-7.
11. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93:1043-65.
12. Lahiri MK, Kannankeril PJ, Goldberger JJ. Assessment of autonomic function in cardiovascular disease: physiological basis and prognostic implications. J Am Coll Cardiol. 2008;51:1725-33.
13. Pumprla J, Howorka K, Groves D, Chester M, Nolan J. Functional assessment of heart rate variability: physiological basis and practical applications. Int J Cardiol. 2002;84:1-14.
14. Ewing DJ, Campbell IW, Clarke BF. The natural history of diabetic autonomic neuropathy. Q J Med. 1980;49:95-108.
15. Li K, Rüdiger H, Ziemssen T. Spectral Analysis of Heart Rate Variability: Time Window Matters. Front Neurol. 2019;10:545.
16. Shaffer F, McCraty R, Zerr CL. A healthy heart is not a metronome: an integrative review of the heart’s anatomy and heart rate variability. Front Psychol. 2014;5:1040.
17. Houle MS, Billman GE. Low-frequency component of the heart rate variability spectrum: a poor marker of sympathetic activity. Am J Physiol. 1999;276:H215-23.
18. Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain. Circulation. 1991;84:482-92.
19. Aktop Z, Tanrıverdi H, Uygur F, İşleyen A, Kalaycı B, Gursoy YC, et al. Diurnal characteristics of heart rate variability in patients with sarcoidosis. Herz. 2017;42:498-504.
20. Uslu N, Akyol A, Gorgulu S, Eren M, Ocakli B, Celik S, et al. Heart rate variability in patients with systemic sarcoidosis. Ann Noninvasive Electrocardiol. 2006;11:38-42.
21. Tiran B, Heller I, Isakov A, Barnea O, Greif J, Topilsky M. Heart rate variability in sarcoidosis: a frequency domain analysis. Eur J Intern Med. 2004;15:518- 22.
22. Hsiao HC, Chiu HW, Lee SC, Kao T, Chang HY, Kong CW. Esophageal PP intervals for analysis of short-term heart rate variability in patients with atrioventricular block before and after insertion of a temporary ventricular inhibited pacemaker. Int J Cardiol. 1998;64:271-6.