Łukasz Rzepiński1,2, Monika Zawadka-Kunikowska3, Julia L Newton4, Paweł Zalewski5,6, Joanna Słomko5. 1. Department of Neurology, 10th Military Research Hospital and Polyclinic, Powstańców Warszawy 5, 85-681, Bydgoszcz, Poland. luk.rzepinski@gmail.com. 2. Sanitas - Neurology Outpatient Clinic, Dworcowa 110, 85-010, Bydgoszcz, Poland. luk.rzepinski@gmail.com. 3. Department of Human Physiology, Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum in Bydgoszcz, Karłowicza 24, 85-092, Bydgoszcz, Poland. 4. The Medical School, Population Health Science Institute, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK. 5. Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, M. Sklodowskiej-Curie 9, 85-094, Bydgoszcz, Poland. 6. Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Warsaw Medical University, 1b Banacha Street, 02-097, Warsaw, Poland.
Abstract
OBJECTIVES: This study evaluates cardiovascular autonomic dysfunction (CAD) in multiple sclerosis (MS) and explores if CAD is related to clinical outcomes and fatigue severity. METHODS: A total of 53 MS patients (30 relapsing-remitting, RRMS; 23 progressive, PMS) and 30 healthy controls were evaluated. TaskForce® Monitor was used to assess impedance cardiography parameters, heart rate (HRV), and blood pressure (BPV) variability during head-up tilt test (HUTT). Expiration/inspiration (E/I) ratio was assessed in response to a deep breathing test. Fatigue severity was evaluated using Chalder Fatigue Scale (CFQ). RESULTS: Compared to controls, PMS patients were characterized by increased sympathetic-parasympathetic ratio at rest (p < 0.01), decreased resting values of parasympathetic parameters (high-frequency HRV, p < 0.05; E/I ratio, p < 0.001), and index of contractility (p < 0.05), whereas RRMS patients showed reduced E/I ratio (p < 0.01). Compared to RRMS group, PMS patients had higher sympathovagal ratio and lower cardiac inotropy parameters (p < 0.05). No intergroup differences were observed for cardiovascular and autonomic function test parameters after HUTT. PMS and low CFQ physical score were identified as independent predictors of sympathetic hyper-reactivity as measured with HRV. Greater disability and male sex were predictors of diastolic BP increase and reduced cardiac inotropy parameters, and older age was predictor of decreased vagal tone (E/I ratio, high-frequency HRV). CONCLUSION: Cardiovascular autonomic modulation is altered in MS and highly dependent on disease variant, disability level, fatigue severity, and patients' demographics.
OBJECTIVES: This study evaluates cardiovascular autonomic dysfunction (CAD) in multiple sclerosis (MS) and explores if CAD is related to clinical outcomes and fatigue severity. METHODS: A total of 53 MS patients (30 relapsing-remitting, RRMS; 23 progressive, PMS) and 30 healthy controls were evaluated. TaskForce® Monitor was used to assess impedance cardiography parameters, heart rate (HRV), and blood pressure (BPV) variability during head-up tilt test (HUTT). Expiration/inspiration (E/I) ratio was assessed in response to a deep breathing test. Fatigue severity was evaluated using Chalder Fatigue Scale (CFQ). RESULTS: Compared to controls, PMS patients were characterized by increased sympathetic-parasympathetic ratio at rest (p < 0.01), decreased resting values of parasympathetic parameters (high-frequency HRV, p < 0.05; E/I ratio, p < 0.001), and index of contractility (p < 0.05), whereas RRMS patients showed reduced E/I ratio (p < 0.01). Compared to RRMS group, PMS patients had higher sympathovagal ratio and lower cardiac inotropy parameters (p < 0.05). No intergroup differences were observed for cardiovascular and autonomic function test parameters after HUTT. PMS and low CFQ physical score were identified as independent predictors of sympathetic hyper-reactivity as measured with HRV. Greater disability and male sex were predictors of diastolic BP increase and reduced cardiac inotropy parameters, and older age was predictor of decreased vagal tone (E/I ratio, high-frequency HRV). CONCLUSION: Cardiovascular autonomic modulation is altered in MS and highly dependent on disease variant, disability level, fatigue severity, and patients' demographics.
Authors: Alan J Thompson; Brenda L Banwell; Frederik Barkhof; William M Carroll; Timothy Coetzee; Giancarlo Comi; Jorge Correale; Franz Fazekas; Massimo Filippi; Mark S Freedman; Kazuo Fujihara; Steven L Galetta; Hans Peter Hartung; Ludwig Kappos; Fred D Lublin; Ruth Ann Marrie; Aaron E Miller; David H Miller; Xavier Montalban; Ellen M Mowry; Per Soelberg Sorensen; Mar Tintoré; Anthony L Traboulsee; Maria Trojano; Bernard M J Uitdehaag; Sandra Vukusic; Emmanuelle Waubant; Brian G Weinshenker; Stephen C Reingold; Jeffrey A Cohen Journal: Lancet Neurol Date: 2017-12-21 Impact factor: 44.182
Authors: Juan Manuel Racosta; Luciano A Sposato; Sarah A Morrow; Lauren Cipriano; Kurt Kimpinski; Kurt Kimpiski; Marcelo Kremenchutzky Journal: Mult Scler Relat Disord Date: 2015-02-23 Impact factor: 4.339
Authors: Tomas Kalincik; Gary Cutter; Tim Spelman; Vilija Jokubaitis; Eva Havrdova; Dana Horakova; Maria Trojano; Guillermo Izquierdo; Marc Girard; Pierre Duquette; Alexandre Prat; Alessandra Lugaresi; Francois Grand'Maison; Pierre Grammond; Raymond Hupperts; Celia Oreja-Guevara; Cavit Boz; Eugenio Pucci; Roberto Bergamaschi; Jeannette Lechner-Scott; Raed Alroughani; Vincent Van Pesch; Gerardo Iuliano; Ricardo Fernandez-Bolaños; Cristina Ramo; Murat Terzi; Mark Slee; Daniele Spitaleri; Freek Verheul; Edgardo Cristiano; José Luis Sánchez-Menoyo; Marcela Fiol; Orla Gray; Jose Antonio Cabrera-Gomez; Michael Barnett; Helmut Butzkueven Journal: Brain Date: 2015-09-10 Impact factor: 13.501
Authors: X Montalban; R Gold; A J Thompson; S Otero-Romero; M P Amato; D Chandraratna; M Clanet; G Comi; T Derfuss; F Fazekas; H P Hartung; E Havrdova; B Hemmer; L Kappos; R Liblau; C Lubetzki; E Marcus; D H Miller; T Olsson; S Pilling; K Selmaj; A Siva; P S Sorensen; M P Sormani; C Thalheim; H Wiendl; F Zipp Journal: Eur J Neurol Date: 2018-01-19 Impact factor: 6.089