Preview

Rational Pharmacotherapy in Cardiology

Advanced search

CLINICAL SIGNIFICANCE OF HEART RATE VARIABILITY INDEXES DERIVED FROM 5-MINUTE AND 24-HOUR ECG RECORDINGS IN PATIENTS WITH RHEUMATOID ARTHRITIS

https://doi.org/10.20996/1819-6446-2009-5-1-77-82

Full Text:

Abstract

Aim. To estimate heart rate variability (HRV) from 5-min and 24-h electrocardiogram (ECG) recordings in female patients with rheumatoid arthritis (RA) and patients of control group, to analyze association between HRV indexes and cardiovascular risk factors and RA-related clinical characteristics.

Material and Methods. 90 female patients with RA and 30 healthy subjects matching for age were included in the study. The baseline evaluation included a physical examination, assessment of the cardiovascular risk factors and RA clinical characteristics, laboratory tests, 5-min and 24-hour ECG recordings. We analyzed the time-domain (SDNN, rMSSD, pNN50), frequency-domain (LF, HF, LF/HF ratio) and nonlinear indexes (SD1, SD2, SD21) of HRV from 5-min ECG recording and the time-domain (SDNN, rMSSD, pNN50) indexes from 24-h ECG recordings.

Results. Patients with RA had lower HRV in comparison with control subjects (p<0,05). We got the following results for 5-min ECG recordings: time-domain (SDNN, rMSSD, pNN50), frequency-domain (LF, HF) and nonlinear indexes (SD1, SD2) negatively correlated with erythrocyte sedimentation rate (ESR) (р<0,05). All parameters of HRV (except for pNN50) strongly negatively correlated with disease activity score (DAS28). LF and HF levels depended on age. The analysis of 24-h ECG recordings showed negative correlation of timedomain indexes (SDNN, rMSSD, pNN50) with DAS28 and ESR.

Conclusion. Reduced HRV is associated with inflammation activity in patient with RA. Low level of HRV and high RA activity are unfavorable cardiovascular factors.

About the Authors

D. A. Anichkov
Russian State Medical University
Russian Federation

Nesterov Department of Faculty Therapy

Leninsky prosp. 8, korp. 10, Moscow, 117049 



A. A. Platonova
Russian State Medical University
Russian Federation

Nesterov Department of Faculty Therapy

Leninsky prosp. 8, korp. 10, Moscow, 117049 



References

1. Wolfe F, Freundlich B, Straus WL. Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis. J Rheumatol 2003; 30:36-40.

2. Solomon DH, Karlson EW, Rimm EB, et al. Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation 2003;107:1303-7.

3. Arden N.K., Edwards C.J., Fisher D.J. et al. The increased risk of myocardial infarction in patients with rheumatoid arthritis is greatest in young women and is not due to traditional risk factors [abstract OP2]. Rheumatology (Oxford) 2006;45 Suppl 1:i1. Available from URL: http://rheumatology.oxfordjournals.org/cgi/reprint/45/suppl_1/i1

4. Szekanecz Z , Kerekes G, Der H, et al. Accelerated atherosclerosis in rheumatoid arthritis. Ann NY Acad Sci 2007;1108:349-58.

5. Del Rincón ID, Williams K, Stern MP, Freeman GL, Escalante A. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum. 2001;44(12):2737-45.

6. Book C, Saxne T, Jacobsson LT. Prediction of mortality in rheumatoid arthritis based on disease activity markers. J Rheumatol. 2005;32(3):430-4.

7. Turesson C, McClelland RL, Christianson TJ, Matteson EL. Severe extra-articular disease manifestations are associated with an increased risk of first ever cardiovascular events in patients with rheumatoid arthritis. Ann Rheum Dis. 2007;66(1):70-5.

8. Naranjo A, Sokka T, Descalzo MA, et al. Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study. Arthritis Res Ther. 2008;10(2):R30.

9. Wallberg-Jonsson S, Ohman ML, Dahlqvist SR. Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in Northern Sweden. J Rheumatol. 1997;24(3):445-51.

10. Maradit-Kremers H, Nicola PJ, Crowson CS, et al. Cardiovascular death in rheumatoid arthritis: a population-based study. Arthritis Rheum. 2005;52(3):722-32.

11. Gonzalez-Gay MA, Gonzalez-Juanatey C, Piñeiro A, et al. High-grade C-reactive protein elevation correlates with accelerated atherogenesis in patients with rheumatoid arthritis. J Rheumatol. 2005;32(7):1219-23.

12. Попкова Т.В., Хелковская А.Н., Мач Э.С. и др. Кардиоваскулярная патология при ревматоидном артрите. Тер арх 2007;79(5):9-14.

13. Kataoka M, Ito C, Sasaki H, Yamane K, Kohno N. Low heart rate variability is a risk factor for sudden cardiac death in type 2 diabetes. Diabetes Res Clin Pract. 2004;64(1):51-8.

14. Dekker JM, Crow RS, Folsom AR, et al. Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC Study. Atherosclerosis Risk In Communities. Circulation. 2000;102(11):1239-44.

15. Lanza GA, Guido V, Galeazzi MM, et al. Prognostic role of heart rate variability in patients with a recent acute myocardial infarction. Am J Cardiol. 1998; 1;82(11):1323-8.

16. Dekker JM, Schouten EG, Klootwijk P, et al. Heart rate variability from short electrocardiographic recordings predicts mortality from all causes in middle-aged and elderly men. The Zutphen Study. Am J Epidemiol. 1997;145(10):899-908.

17. Sloan RP, McCreath H, Tracey KJ, et al. RR interval variability is inversely related to inflammatory markers: the CARDIA study. Mol Med. 2007;13(3-4):178-84.

18. Psychari SN, Apostolou TS, Iliodromitis EK, et al. Inverse relation of C-reactive protein levels to heart rate variability in patients after acute myocardial infarction. Hellenic J Cardiol. 2007;48(2):64-71.

19. Kon H, Nagano M, Tanaka F, et al. Association of decreased variation of R-R interval and elevated serum C-reactive protein level in a general population in Japan. Int Heart J. 2006;47(6):867-76.

20. Sajadieh A, Nielsen OW, Rasmussen V, et al. 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(5):363-70.

21. Madsen T, Christensen JH, Toft E, Schmidt EB. C-reactive protein is associated with heart rate variability. Ann Noninvasive Electrocardiol. 2007;12(3):216-22.

22. Evrengül H, Dursunoglu D, Cobankara V, et al. Heart rate variability in patients with rheumatoid arthritis. Rheumatol Int. 2004;24(4):198-202.

23. Парнес Е.Я., Красносельский М.Я., Цурко В.В., Стрюк Р.И. Долгосрочный прогноз у больных ревматоидным артритом в зависимости от исходной вариабельности сердечного ритма. Тер арх 2005;(9):77-80.

24. 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(5):777-83.

25. Liao D, Carnethon M, Evans GW, et al. Lower heart rate variability is associated with the development of coronary heart disease in individuals with diabetes: the atherosclerosis risk in communities (ARIC) study. Diabetes. 2002;51(12):3524-31.

26. La Rovere MT, Pinna GD, Maestri R, et al. Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients. Circulation. 2003;107(4)565-70.

27. Steeds R, Fletcher J, Smith M, et al. Prognostic significance of early short-term measurements of heart rate variability following acute myocardial infarction. Am J Cardiol. 2004;94(10):1275-8.

28. Niskanen JP, Tarvainen MP, Ranta-Aho PO, Karjalainen PA. Software for advanced HRV analysis. Comput Methods Programs Biomed 2004;76(1):73-81.

29. Piskorski J, Guzik P. Geometry of the Poincaré plot of RR intervals and its asymmetry in healthy adults. Physiol Meas. 2007;28(3):287-300.

30. Antelmi I, de Paula RS, Shinzato AR, et al. 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.

31. Haensel A, Mills PJ, Nelesen RA, et al. The relationship between heart rate variability and inflammatory markers in cardiovascular diseases. Psychoneuroendocrinology. 2008;33(10):1305-12.

32. Nolan RP, Reid GJ, Seidelin PH, Lau HK. C-reactive protein modulates vagal heart rate control in patients with coronary artery disease. Clin Sci (Lond). 2007;112(8):449-56.

33. Borovikova LV, Ivanova S, Zhang M, et al. Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin. Nature 2002;405:458-62.

34. Saeed RW, Varma S, Peng-Nemeroff T, et al. Cholinergic stimulation blocks endothelial cell activation and leukocyte recruitment during inflammation. J Exp Med. 2005;201(7):1113- 23.

35. Mioni C, Bazzani C, Giuliani D, et al. Activation of an efferent cholinergic pathway produces strong protection against myocardial ischemia/reperfusion injury in rats. Crit Care Med. 2005;33(11):2621-8.

36. Tracey KJ. The inflammatory reflex. Nature. 2002;420:853-9.

37. Marsland AL, Gianaros PJ, Prather AA, et al. Stimulated production of proinflammatory cytokines covaries inversely with heart rate variability. Psychosom Med. 2007;69(8):709- 16.

38. 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(2):402-11.

39. Goldberger JJ, Cain ME, Hohnloser SH, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death. A scientific statement from the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention. J Am Coll Cardiol. 2008;52(14):1179-99.

40. Paraskevas KI. Statin treatment for rheumatoid arthritis: a promising novel indication. Clin Rheumatol. 2008;27(3):281-7.


For citation:


Anichkov D.A., Platonova A.A. CLINICAL SIGNIFICANCE OF HEART RATE VARIABILITY INDEXES DERIVED FROM 5-MINUTE AND 24-HOUR ECG RECORDINGS IN PATIENTS WITH RHEUMATOID ARTHRITIS. Rational Pharmacotherapy in Cardiology. 2009;5(1):77-82. (In Russ.) https://doi.org/10.20996/1819-6446-2009-5-1-77-82

Views: 1458


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)