Subclinical cardiac structural and electrical abnormalities in fibromyalgia syndrome

Background/aim: In the literature, there is a paucity of data about the effects of fibromyalgia syndrome FMS on myocardial function and electrophysiological properties of atrium and ventricles. In this study, we investigated cardiac functions and noninvasive predictors of arrhythmias in patients with FMS. Materials and methods: The study included 43 female patients diagnosed with FMS and 30 age- and sex-matched healthy subjects. The presence of fragmented QRS fQRS morphology, P dispersion, QT dispersion, inter- and intraatrial electromechanical delay was evaluated in the groups with 12-lead ECG and standard and tissue Doppler echocardiography. Results: Among electrocardiographic parameters, P dispersion, QT dispersion, and the ratio of presence of fQRS morphology were found to be significantly higher in the study group as compared to the control group. In lateral and septal, the ratio of the early transmitral flow velocity to the early diastolic tissue velocity E/Em was significantly higher in the study group. Additionally, intra- and interatrial electromechanical delay was found significantly prolonged in the study group. Conclusion: FMS is found to be associated with significant cardiac electrical alterations that may indicate the increased risk of atrial and ventricular arrhythmias in this group of patients.

___

  • 1. Bellato E, Marini E, Castoldi F, Barbasetti N, Mattei L et al. Fibromyalgia syndrome: etiology, pathogenesis, diagnosis, and treatment. Pain Research and Treatment 2012; 2012: 426130. doi: 10.1155/2012/426130
  • 2. Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis & Rheumatology 1995; 38(1): 19-28. doi: 10.1002/ art.1780380104
  • 3. Mease P. Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. Journal of Rheumatology Supplement 2005; 75: 6-21.
  • 4. Cohen H, Neumann L, Shore M, Amir M, Cassuto Y et al. Autonomic dysfunction in patients with fibromyalgia: application of power spectral analysis of heart rate variability. Seminars in Arthritis and Rheumatism 2000; 29(4): 217-227. doi: 10.1016/ s0049-0172(00)80010-4
  • 5. Tsuji H, Larson MG, Venditti FJ Jr, Manders ES, Evans JC et al. Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation 1996; 94(11): 2850-5. doi: 10.1161/01.cir.94.11.2850
  • 6. da Cunha Ribeiro RP, Roschel H, Artioli GG, Dassouki T, Perandini LA et al. Cardiac autonomic impairment and chronotropic incompetence in fibromyalgia. Arthritis Research & Therapy 2011; 13(6): R190. doi: 10.1186/ar3519
  • 7. Bölük H, Öztürk GT, Cömert D, Ersöz M. Increased carotid intima-media thickness in female patients with fibromyalgia: a preliminary study. Archives of Rheumatology 2015; 30: 307-310. doi: 10.5606/ArchRheumatol.2015.5639
  • 8. Tsai PS, Fan YC, Huang CJ. Fibromyalgia is associated with coronary heart disease: a population-based cohort study. Regional Anesthesia & Pain Medicine 2015; 40(1): 37-42. doi: 10.1097/ AAP.0000000000000190
  • 9. Dogru MT, Aydin G, Tosun A, Keleş I, Güneri M et al. Correlations between autonomic dysfunction and circadian changes and arrhythmia prevalence in women with fibromyalgia syndrome. The Anatolian Journal of Cardiology 2009; 9(2): 110-117.
  • 10. Sayilir S, Ergün G, Ekiz T. Evaluation of Ventricular Diastolic Function in Patients With Fibromyalgia Syndrome. Archives of Rheumatology 2018; 33(2): 150-153. doi: 10.5606/ ArchRheumatol.2018.6541
  • 11. Lee JH, Cho KI, Kim SM, Lee HG, Kim TI. Arterial stiffness in female patients with fibromyalgia and its relationship to chronic emotional and physical stress. Korean Circulation Journal 2011; 41(10): 596-602. doi: 10.4070/kcj.2011.41.10.596
  • 12. Yolbaş S, Yıldırım A, Düzenci D, Karakaya B, Dağlı MN et al. QT dispersion and P wave dispersion in patients with fibromyalgia. European Journal of Rheumatology 2016; 3(4): 165-168. doi: 10.5152/eurjrheum.2016.042
  • 13. Naschitz JE, Slobodin G, Sharif D, Fields M, Isseroff H et al. Electrocardiographic QT interval and cardiovascular reactivity in fibromyalgia differ from chronic fatigue syndrome. European Journal of Internal Medicine 2008; 19(3): 187-191. doi: 10.1016/j.ejim.2007.08.003
  • 14. Avci BK, Gulmez O, Donmez G, Pehlivanoglu S. Early Changes in Atrial Electromechanical Coupling in Patients with Hypertension: Assessment by Tissue Doppler Imaging. Chinese Medical Journal (Engl) 2016; 129(11): 1311-1315. doi: 10.4103/0366-6999.182846
  • 15. Esen Ö, Akçakoyun M, Açar G, Bulut M, Alızade E et al. Acute sleep deprivation is associated with increased atrial electromechanical delay in healthy young adults. Pacing and Clinical Electrophysiology 2011; 34(12): 1645-1651. doi: 10.1111/j.1540-8159.2008.01013.x
  • 16. Das MK, Zipes DP. Fragmented QRS: a predictor of mortality and sudden cardiac death. Heart Rhythm Journal 2009; 6(3): 8-14. doi: 10.1016/j.hrthm.2008.10.019
  • 17. Jain R, Singh R, Yamini S, Das MK. Fragmented ECG as a risk marker in cardiovascular diseases. Current Cardiology Reviews 2014; 10(3): 277-286. doi: 10.2174/1573403x1066614 0514103451
  • 18. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care & Research 2010; 62(5): 600-10. doi: 10.1002/acr.20140
  • 19. Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: development and validation. The Journal of Rheumatology 1991; 18(5): 728-733.
  • 20. Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation 2006; 113(21): 2495-2501. doi: 10.1161/CIRCULATIONAHA.105.595892
  • 21. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. Journal of the American Society of Echocardiography 2005; 18(12): 1440-1463. doi: 10.1016/j. echo.2005.10.005
  • 22. Russell IJ, Larson AA. Neurophysiopathogenesis of fibromyalgia syndrome: a unified hypothesis. Rheumatic Disease Clinics of North America 2009; 35(2): 421-435. doi: 10.1016/j.rdc.2009.06.005
  • 23. Furlan R, Colombo S, Perego F, Atzeni F, Diana A et al. Abnormalities of cardiovascular neural control and reduced orthostatic tolerance in patients with primary fibromyalgia. The Journal of Rheumatology 2005; 32(9): 1787-1793.
  • 24. Meeus M, Goubert D, De Backer F, Struyf F, Hermans L et al. Heart rate variability in patients with fibromyalgia and patients with chronic fatigue syndrome: a systematic review. Seminars in Arthritis and Rheumatism 2013; 43(2): 279-287. doi: 10.1016/j.semarthrit.2013.03.004
  • 25. Raj SR, Brouillard D, Simpson CS, Hopman WM, Abdollah H. Dysautonomia among patients with fibromyalgia: a noninvasive assessment. The Journal of Rheumatology 2000; 27(11): 2660-2665.
  • 26. Thayer JF, Brosschot JF. Psychosomatics and psychopathology: looking up and down from the brain. Psychoneuroendocrinology 2005; 30(10): 1050-1058. doi: 10.1016/j.psyneuen.2005.04.014
  • 27. Inal S, İnal EE, Okyay GU, Öztürk GT, Öneç K et al. Fibromyalgia and nondipper circadian blood pressure variability. Journal of Clinical Rheumatology 2014; 20(8): 422-426. doi: 10.1097/ RHU.0000000000000189
  • 28. Kim SK, Kim KS, Lee YS, Park SH, Choe JY. Arterial stiffness and proinflammatory cytokines in fibromyalgia syndrome. Clinical and Experimental Rheumatology 2010; 28(6 Suppl 63): 71-77.
  • 29. Cordero MD, Alcocer-Gómez E, Cano-García FJ, SánchezDomínguez B, Fernández-Riejo P et al. Clinical symptoms in fibromyalgia are associated to overweight and lipid profile. Rheumatology International 2014; 34(3): 419-422. doi: 10.1007/s00296-012-2647-2
  • 30. Gurer G, Sendur OF, Ay C. Serum lipid profile in fibromyalgia women. Clinical Rheumatology 2006; 25(3): 300-303. doi: 10.1007/s10067-005-0004-5
  • 31. Balbaloglu O, Ede H, Yolcu S, Ak H, Tanik N et al. Exercise Profile and Diastolic Functions Measured via Tissue Doppler Imaging of Fibromyalgia Patients. Journal of Clinical Medicine Research 2014; 6(3): 184-189. doi: 10.14740/jocmr1799w
  • 32. Cui QQ, Zhang W, Wang H, Sun X, Wang R et al. Assessment of atrial electromechanical coupling and influential factors in nonrheumatic paroxysmal atrial fibrillation. Clinical Cardiology 2008; 31(2): 74-78. doi: 10.1002/clc.20162
  • 33. Aizawa Y, Watanabe H, Okumura K. Electrocardiogram (ECG) for the Prediction of Incident Atrial Fibrillation: An Overview. Journal of Atrial Fibrillation 2017; 10(4): 1724. doi: 10.4022/ jafib.1724
  • 34. De Vos CB, Weijs B, Crijns HJ, Cheriex EC, Palmans A et al. Atrial tissue Doppler imaging for prediction of new-onset atrial fibrillation. Heart. 2009; 95(10): 835-840. doi: 0.1136/ hrt.2008.148528.
  • 35. Maffè S, Paffoni P, Dellavesa P, Cucchi L, Zenone F et al. Prognostic value of total atrial conduction time measured with tissue Doppler imaging to predict the maintenance of sinus rhythm after external electrical cardioversion of persistent atrial fibrillation. Echocardiography 2015; 32(3): 420-427. doi: 10.1111/echo.12702.
  • 36. Lane RD, Zareba W, Reis HT, Peterson DR, Moss AJ. Changes in ventricular repolarization duration during typical daily emotion in patients with Long QT syndrome. Psychosomatic Medicine 2011; 73(1): 98-105. doi: 10.1097/ PSY. 0b013e318203310a
  • 37. Das MK, Suradi H, Maskoun W, Michael MA, Shen C et al. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circulation: Arrhythmia and Electrophysiology 2008; 1(4): 258-268. doi: 10.1161/CIRCEP. 107.763284
  • 38. Eyuboglu M, Akdeniz B. Association Between Non-Dipping and Fragmented QRS Complexes in Prehypertensive Patients. Arquivos Brasileiros de Cardiologia 2019; 112(1): 59-64. doi: 10.5935/abc.20180242
  • 39. Eyuboglu M. Fragmented QRS as a Marker of Myocardial Fibrosis in Hypertension: a Systematic Review. Current Hypertension Reports 2019; 21(10): 73. doi: 10.1007/s11906- 019-0982-3