nach oben

Clinical Rheumatology

Erschienen in:

25.03.2020 | Original Article

Evaluation of cardiac autonomic nervous system in patients with ankylosing spondylitis using 12-lead electrocardiography and Holter monitoring

verfasst von: Mustafa Candemir, Burcu Candemir, Adem Ertürk

Erschienen in: Clinical Rheumatology | Ausgabe 9/2020

Einloggen, um Zugang zu erhalten

Abstract

Objectives

Ankylosing spondylitis (AS) is associated with increased risk of cardiovascular problems, including complications such as conduction defects and arrhythmias, which might lead to increased morbidity and/or mortality. The objective of the present study is to evaluate the electrocardiographic (ECG) parameters, including T-peak to T-end intervals (Tpe), Tpe/corrected QT (QTc) ratio, heart rate variability (HRV), and heart rate turbulence (HRT) in AS patients.

Methods

Seventy-six AS patients and 55 control subjects were included in the study. 12-lead ECG and 24-h Holter monitoring recordings were obtained. Tpe and Tpe/QTc were measured using the 12-lead ECG and HRV and HRT parameters were assessed using 24-h Holter ECG recordings. Subjects were assigned into three groups based on their HRT parameters (Tonset (TO) and Tslope (TS)) (HRT-0, normal TO or TS; HRT-1, abnormal TO or TS; HRT-2, abnormal TO and TS).

Results

Tpe was prolonged and Tpe/QTc ratio was higher in AS patients (p < 0.001 for both). Moreover, Tpe and Tpe/QTc ratio significantly correlated with disease duration. All HRV parameters (VLF, LF, HF, SDNN, SDANN, ASDNN, rMSSD, pNN50) were decreased in AS patients in comparison with those in control subjects (p < 0.05 for all parameters). Controls were significantly more likely to have normal TO and TS (82% vs 53%, p < 0.001). There was negative correlation between Holter parameters and disease duration, as well as Tpe and Tpe/QTc ratio (p < 0.05 for all parameters).

Conclusions

This study demonstrated that AS patients have disrupted ventricular repolarization (increased Tpe, Tpe/QTc ratio). Results suggest a decreased cardiac impact of the parasympathetic system in AS patients.

Key Points

• This study demonstrated that AS patients have disrupted ventricular repolarization.

• The study also finds that heart rate turbulence and heart rate variability are impaired in AS patients.

• Impaired Holter and ECG parameters may be one of the high cardiovascular risk factors in AS patients.

van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368CrossRef

Bergfeldt L, Edhag O, Vallin H (1982) Cardiac conduction disturbances, an underestimated manifestation in ankylosing spondylitis. A 25-year follow-up study of 68 patients. Acta Med Scand 212(4):217–223CrossRef

Bergfeldt L, Edhag O, Vedin L, Vallin H (1982) Ankylosing spondylitis: an important cause of severe disturbances of the cardiac conduction system. Prevalence among 223 pacemaker-treated men. Am J Med 73(2):187–191. https://doi.org/10.1016/0002-9343(82)90177-2CrossRefPubMed

Bulkley BH, Roberts WC (1973) Ankylosing spondylitis and aortic regurgitation. Description of the characteristic cardiovascular lesion from study of eight necropsy patients. Circulation 48(5):1014–1027. https://doi.org/10.1161/01.cir.48.5.1014CrossRefPubMed

Heslinga SC, Van Dongen CJ, Konings TC, Peters MJ, Van der Horst-Bruinsma IE, Smulders YM, Nurmohamed MT (2014) Diastolic left ventricular dysfunction in ankylosing spondylitis--a systematic review and meta-analysis. Semin Arthritis Rheum 44(1):14–19. https://doi.org/10.1016/j.semarthrit.2014.02.004CrossRefPubMed

Julkunen H (1966) Atrioventricular conduction defect in ankylosing spondylitis. Geriatrics 21(10):129–131PubMed

O’Neill TW, Bresnihan B (1992) The heart in ankylosing spondylitis. Ann Rheum Dis 51(6):705–706. https://doi.org/10.1136/ard.51.6.705CrossRefPubMedPubMedCentral

Kazmierczak J, Peregud-Pogorzelska M, Biernawska J, Przepiera-Bedzak H, Goracy J, Brzosko I, Plonska E, Brzosko M (2007) Cardiac arrhythmias and conduction disturbances in patients with ankylosing spondylitis. Angiology 58(6):751–756. https://doi.org/10.1177/0003319707299208CrossRefPubMed

Forsblad-d’Elia H, Wallberg H, Klingberg E, Carlsten H, Bergfeldt L (2013) Cardiac conduction system abnormalities in ankylosing spondylitis: a cross-sectional study. BMC Musculoskelet Disord 14:237. https://doi.org/10.1186/1471-2474-14-237CrossRefPubMedPubMedCentral

10.

Radford EP, Doll R, Smith PG (1977) Mortality among patients with ankylosing spondylitis not given X-ray therapy. N Engl J Med 297(11):572–576. https://doi.org/10.1056/nejm197709152971103CrossRefPubMed

11.

Umetani K, Singer DH, McCraty R, Atkinson M (1998) Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades. J Am Coll Cardiol 31(3):593–601CrossRef

12.

Otzenberger H, Gronfier C, Simon C, Charloux A, Ehrhart J, Piquard F, Brandenberger G (1998) Dynamic heart rate variability: a tool for exploring sympathovagal balance continuously during sleep in men. Am J Phys 275(3):H946–H950. https://doi.org/10.1152/ajpheart.1998.275.3.H946CrossRef

13.

DeGiorgio CM, Miller P, Meymandi S, Chin A, Epps J, Gordon S, Gornbein J, Harper RM (2010) RMSSD, a measure of vagus-mediated heart rate variability, is associated with risk factors for SUDEP: the SUDEP-7 inventory. Epilepsy Behav 19(1):78–81. https://doi.org/10.1016/j.yebeh.2010.06.011

14.

Taylor JA, Carr DL, Myers CW, Eckberg DL (1998) Mechanisms underlying very-low-frequency RR-interval oscillations in humans. Circulation 98(6):547–555. https://doi.org/10.1161/01.cir.98.6.547CrossRefPubMed

15.

Reyes del Paso GA, Langewitz W, Mulder LJ, van Roon A, Duschek S (2013) The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: a review with emphasis on a reanalysis of previous studies. Psychophysiology 50(5):477–487. https://doi.org/10.1111/psyp.12027CrossRefPubMed

16.

Grossman P, Taylor EW (2007) Toward understanding respiratory sinus arrhythmia: relations to cardiac vagal tone, evolution and biobehavioral functions. Biol Psychol 74(2):263–285. https://doi.org/10.1016/j.biopsycho.2005.11.014CrossRefPubMed

17.

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 (1996). Circulation 93 (5):1043–1065

18.

Bigger JT Jr, Fleiss JL, Steinman RC, Rolnitzky LM, Kleiger RE, Rottman JN (1992) Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation 85(1):164–171. https://doi.org/10.1161/01.cir.85.1.164CrossRefPubMed

19.

Tsuji H, Venditti FJ Jr, Manders ES, Evans JC, Larson MG, Feldman CL, Levy D (1994) Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham Heart Study. Circulation 90(2):878–883. https://doi.org/10.1161/01.cir.90.2.878CrossRefPubMed

20.

Lin LY, Lai LP, Lin JL, Du CC, Shau WY, Chan HL, Tseng YZ, Huang SK (2002) Tight mechanism correlation between heart rate turbulence and baroreflex sensitivity: sequential autonomic blockade analysis. J Cardiovasc Electrophysiol 13(5):427–431CrossRef

21.

Castro Hevia J, Antzelevitch C, Tornes Barzaga F, Dorantes Sanchez M, Dorticos Balea F, Zayas Molina R, Quinones Perez MA, Fayad Rodriguez Y (2006) Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol 47(9):1828–1834. https://doi.org/10.1016/j.jacc.2005.12.049CrossRefPubMed

22.

Erikssen G, Liestol K, Gullestad L, Haugaa KH, Bendz B, Amlie JP (2012) The terminal part of the QT interval (T peak to T end): a predictor of mortality after acute myocardial infarction. Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc 17(2):85–94. https://doi.org/10.1111/j.1542-474X.2012.00493.xCrossRef

23.

Tsuji H, Larson MG, Venditti FJ Jr, Manders ES, Evans JC, Feldman CL, Levy D (1996) Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation 94(11):2850–2855. https://doi.org/10.1161/01.cir.94.11.2850CrossRefPubMed

24.

Schmidt G, Malik M, Barthel P, Schneider R, Ulm K, Rolnitzky L, Camm AJ, Bigger JT Jr, Schomig A (1999) Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction. Lancet (London, England) 353(9162):1390–1396. https://doi.org/10.1016/s0140-6736(98)08428-1CrossRef

25.

Martins NA, Furtado GE, Campos MJ, Leitao JC, Filaire E, Ferreira JP (2014) Exercise and ankylosing spondylitis with New York modified criteria: a systematic review of controlled trials with meta-analysis. Acta Reumatol Port 39(4):298–308PubMed

26.

Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing spondylitis disease activity index. J Rheumatol 21(12):2286–2291PubMed

27.

Gunes Y, Tuncer M, Guntekin U, Sahin M, Yazmalar L (2009) Effects of ankylosing spondylitis on the heart. Acta Cardiol 64(3):385–392. https://doi.org/10.2143/ac.64.3.2038026CrossRefPubMed

28.

Kaya EB, Okutucu S, Aksoy H, Karakulak UN, Tulumen E, Ozdemir O, Inanici F, Aytemir K, Kabakci G, Tokgozoglu L, Ozkutlu H, Oto A (2010) Evaluation of cardiac autonomic functions in patients with ankylosing spondylitis via heart rate recovery and heart rate variability. Clinical Research in Cardiology : Official Journal of the German Cardiac Society 99(12):803–808. https://doi.org/10.1007/s00392-010-0187-xCrossRef

29.

Yildirir A, Aksoyek S, Calguneri M, Aytemir K, Kabakci G, Ovunc K, Nazli N, Ozmen F, Oto A, Kes S (2000) QT dispersion as a predictor of arrhythmic events in patients with ankylosing spondylitis. Rheumatology (Oxford, England) 39(8):875–879. https://doi.org/10.1093/rheumatology/39.8.875CrossRef

30.

Borman P, Gokoglu F, Kocaoglu S, Yorgancioglu ZR (2008) The autonomic dysfunction in patients with ankylosing spondylitis: a clinical and electrophysiological study. Clin Rheumatol 27(10):1267–1273. https://doi.org/10.1007/s10067-008-0906-0CrossRefPubMed

31.

Thayer JF, Yamamoto SS, Brosschot JF (2010) The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol 141(2):122–131. https://doi.org/10.1016/j.ijcard.2009.09.543CrossRefPubMed

32.

Thomsen NH, Horslev-Petersen K, Beyer JM (1986) Ambulatory 24-hour continuous electrocardiographic monitoring in 54 patients with ankylosing spondylitis. Eur Heart J 7(3):240–246. https://doi.org/10.1093/oxfordjournals.eurheartj.a062058CrossRefPubMed

33.

Lehtinen K (1993) Mortality and causes of death in 398 patients admitted to hospital with ankylosing spondylitis. Ann Rheum Dis 52(3):174–176. https://doi.org/10.1136/ard.52.3.174CrossRefPubMedPubMedCentral

34.

Shaffer F, Ginsberg JP (2017) An overview of heart rate variability metrics and norms. Front Public Health 5:258. https://doi.org/10.3389/fpubh.2017.00258CrossRefPubMedPubMedCentral

35.

Ponikowski P, Anker SD, Chua TP, Szelemej R, Piepoli M, Adamopoulos S, Webb-Peploe K, Harrington D, Banasiak W, Wrabec K, Coats AJ (1997) Depressed heart rate variability as an independent predictor of death in chronic congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 79(12):1645–1650. https://doi.org/10.1016/s0002-9149(97)00215-4CrossRefPubMed

36.

La Rovere MT, Bigger JT Jr, Marcus FI, Mortara A, Schwartz PJ (1998) Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes after Myocardial Infarction) Investigators. Lancet (London, England) 351(9101):478–484. https://doi.org/10.1016/s0140-6736(97)11144-8CrossRef

37.

Toussirot E, Bahjaoui-Bouhaddi M, Poncet JC, Cappelle S, Henriet MT, Wendling D, Regnard J (1999) Abnormal autonomic cardiovascular control in ankylosing spondylitis. Ann Rheum Dis 58(8):481–487. https://doi.org/10.1136/ard.58.8.481CrossRefPubMedPubMedCentral

38.

Poddubnyi DA, Gaidukova IZ, Rebrov AP (2009) Heart rate variability in patients with ankylosing spondylitis (Bekhterev’s disease). Terapevticheskii arkhiv 81(6):56–62PubMed

39.

Wei CY, Kung WM, Chou YS, Wang YC, Tai HC, Wei JC (2016) Cardiac autonomic function in patients with ankylosing spondylitis: a case-control study. Medicine 95(21):e3749. https://doi.org/10.1097/md.0000000000003749CrossRefPubMedPubMedCentral

40.

Yildirir A, Aksoyek S, Calguneri M, Aytemir K, Apras S, Kiraz S, Kabakci G, Ovunc K, Oto A, Kes S (2001) No evidence of cardiac autonomic involvement in ankylosing spondylitis, as assessed by heart rate variability. Clin Rheumatol 20(3):185–188CrossRef

41.

Pagani M, Lombardi F, Guzzetti S, Sandrone G, Rimoldi O, Malfatto G, Cerutti S, Malliani A (1984) Power spectral density of heart rate variability as an index of sympatho-vagal interaction in normal and hypertensive subjects. Journal of Hypertension Supplement : Official Journal of the International Society of Hypertension 2(3):S383–S385

42.

Lin K, Wei L, Huang Z, Zeng Q (2017) Combination of Ewing test, heart rate variability, and heart rate turbulence analysis for early diagnosis of diabetic cardiac autonomic neuropathy. Medicine 96(45):e8296. https://doi.org/10.1097/md.0000000000008296CrossRefPubMedPubMedCentral

43.

Cygankiewicz I (2013) Heart rate turbulence. Prog Cardiovasc Dis 56(2):160–171. https://doi.org/10.1016/j.pcad.2013.08.002CrossRefPubMed

44.

Ghuran A, Reid F, La Rovere MT, Schmidt G, Bigger JT Jr, Camm AJ, Schwartz PJ, Malik M (2002) Heart rate turbulence-based predictors of fatal and nonfatal cardiac arrest (the autonomic tone and reflexes after myocardial infarction substudy). Am J Cardiol 89(2):184–190. https://doi.org/10.1016/s0002-9149(01)02198-1CrossRefPubMed

45.

Peeters AJ, ten Wolde S, Sedney MI, de Vries RR, Dijkmans BA (1991) Heart conduction disturbance: an HLA-B27 associated disease. Ann Rheum Dis 50(6):348–350. https://doi.org/10.1136/ard.50.6.348CrossRefPubMedPubMedCentral

46.

Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT, Yan GX (2008) T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 41(6):567–574. https://doi.org/10.1016/j.jelectrocard.2008.07.016CrossRefPubMed

47.

Zhao X, Xie Z, Chu Y, Yang L, Xu W, Yang X, Liu X, Tian L (2012) Association between Tp-e/QT ratio and prognosis in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Clin Cardiol 35(9):559–564. https://doi.org/10.1002/clc.22022CrossRefPubMedPubMedCentral

48.

Acar G, Yorgun H, Inci MF, Akkoyun M, Bakan B, Nacar AB, Dirnak I, Cetin GY, Bozoglan O (2014) Evaluation of Tp-e interval and Tp-e/QT ratio in patients with ankylosing spondylitis. Mod Rheumatol 24(2):327–330. https://doi.org/10.3109/14397595.2013.854072CrossRefPubMed

Titel: Evaluation of cardiac autonomic nervous system in patients with ankylosing spondylitis using 12-lead electrocardiography and Holter monitoring
verfasst von: Mustafa Candemir
Burcu Candemir
Adem Ertürk
Publikationsdatum: 25.03.2020
Verlag: Springer International Publishing
Erschienen in: Clinical Rheumatology / Ausgabe 9/2020
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-020-05046-y

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Objectives

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 9/2020

Concomitant new diagnosis of systemic lupus erythematosus and COVID-19 with possible antiphospholipid syndrome. Just a coincidence? A case report and review of intertwining pathophysiology

Dysregulation of gut microbiome is linked to disease activity of rheumatic diseases

Risk of systemic autoimmune diseases in gastric disease patients with proton pump inhibitor use: a nationwide cohort study in Taiwan

18F-FDG PET/CT in bone sarcoidosis: an observational study

Evaluation of the immune response to hepatitis B vaccine in patients on biological therapy: results of the RIER cohort study