Chronotropic Incompetence and Reduced Heart Rate Recovery in Rheumatoid Arthritis

Peçanha, Tiago; Rodrigues, R. W. P.; Pinto, André Luíz de Carvalho Braule; Sá-Pinto, Ana Lúcia de; Guedes, Lissiane Karine Noronha; Bonfiglioli, Karina Rossi; Gualano, Bruno; Roschel, Hamilton

doi:10.1097/rhu.0000000000000745

Cited by 9 publications

(11 citation statements)

References 47 publications

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“…Most of the studies report a reduction in cardiac parasympathetic activity ( n = 20/26 studies, prevalence 77%) assessed through a reduced heart rate variability (HRV), that is a noninvasive method to investigate the status of cardiovascular autonomic control, and a high Resting Heart Rate (RHR) [ 113 ]. Under a physical effort, when compared to healthy subjects, RA patients have a reduced chronotropic response to exercise and slower heart rate recovery post-maximal exercise test [ 114 ]. Sympathetic hyperactivity has been documented in approximately half of the studies included in the aforementioned review ( n = 16/30 studies, prevalence 53%), but the evidence is weaker since its measurement tools (e.g., clinical cardiovascular tests, neuropeptide Y, serum chromogranin, urinary or plasmatic catecholamines, pupillary light reflex, etc.)…”

Section: Autonomic Nervous System and Its Interplay With Inflammation...mentioning

confidence: 99%

The Interplay between Autonomic Nervous System and Inflammation across Systemic Autoimmune Diseases

Bellocchi

Carandina

Montinaro

et al. 2022

IJMS

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The autonomic nervous system (ANS) and the immune system are deeply interrelated. The ANS regulates both innate and adaptive immunity through the sympathetic and parasympathetic branches, and an imbalance in this system can determine an altered inflammatory response as typically observed in chronic conditions such as systemic autoimmune diseases. Rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis all show a dysfunction of the ANS that is mutually related to the increase in inflammation and cardiovascular risk. Moreover, an interaction between ANS and the gut microbiota has direct effects on inflammation homeostasis. Recently vagal stimulation techniques have emerged as an unprecedented possibility to reduce ANS dysfunction, especially in chronic diseases characterized by pain and a decreased quality of life as well as in chronic inflammation.

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Section: Autonomic Nervous System and Its Interplay With Inflammation...mentioning

confidence: 99%

The Interplay between Autonomic Nervous System and Inflammation across Systemic Autoimmune Diseases

Bellocchi

Carandina

Montinaro

et al. 2022

IJMS

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“…2016) and slower HR recovery after exercise (Pecanha et al . 2018), which are considered to be strong independent predictors of CVD and mortality (Kjeldsen et al . 1997; Cole et al .…”

Section: Discussionmentioning

confidence: 99%

“…Significantly less information is available on the cardiovascular and autonomic responses to exercise in RA. Recent studies have reported increased rates of hypertensive response to exercise in RA patients (Klemz et al 2016) and slower HR recovery after exercise (Pecanha et al 2018), which are considered to be strong independent predictors of CVD and mortality (Kjeldsen et al 1997;Cole et al 1999). These abnormal responses suggest augmented sympathetic responses to exercise and impairment in the neural control of circulation in these patients, which has not been investigated in RA yet.…”

Section: Discussionmentioning

confidence: 99%

“…2016) and reduced post‐exercise heart rate (HR) recovery (Pecanha et al . 2018), which are both independent predictors of cardiovascular and cerebrovascular events, such as myocardial infarction and stroke (Kjeldsen et al . 1997; Kurl et al .…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, ANS dysfunction in RA is present not only in resting conditions but also in response to acute physiological stress, such as exercise. Indeed, patients with RA show an increased blood pressure (BP) response to exercise (Klemz et al 2016) and reduced post-exercise heart rate (HR) recovery (Pecanha et al 2018), which are both independent predictors of cardiovascular and cerebrovascular events, such as myocardial infarction and stroke (Kjeldsen et al 1997;Kurl et al 2001).…”

Section: Introductionmentioning

confidence: 99%

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Increased sympathetic and haemodynamic responses to exercise and muscle metaboreflex activation in post‐menopausal women with rheumatoid arthritis

Peçanha

Meireles

Pinto

et al. 2020

The Journal of Physiology

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Key points Rheumatoid arthritis (RA) patients present exacerbated blood pressure responses to exercise, but little is known regarding the underlying mechanisms involved. This study assessed autonomic and haemodynamic responses to exercise and to the isolated activation of muscle metaboreflex in post‐menopausal women with RA. Participants with RA showed augmented pressor and sympathetic responses to exercise and to the activation of muscle metaboreflex. These responses were associated with multiple pro‐ and anti‐inflammatory cytokines and with pain. The results of the present study support the suggestion that an abnormal reflex control of circulation is an important mechanism underlying the exacerbated cardiovascular response to exercise and increased cardiovascular risk in RA. Abstract Studies have reported abnormal cardiovascular responses to exercise in rheumatoid arthritis (RA) patients, but little is known regarding the underlying mechanisms involved. This study assessed haemodynamic and sympathetic responses to exercise and to the isolated activation of muscle metaboreflex in women diagnosed with RA. Thirty‐three post‐menopausal women diagnosed with RA and 10 matched controls (CON) participated in this study. Mean arterial pressure (MAP), heart rate (HR) and muscle sympathetic nerve activity (MSNA frequency and incidence) were measured during a protocol of isometric knee extension exercise (3 min, 30% of maximal voluntary contraction), followed by post‐exercise ischaemia (PEI). Participants with RA showed greater increases in MAP and MSNA during exercise and PEI than CON (ΔMAPexercise = 16 ± 11 vs. 9 ± 6 mmHg, P = 0.03; ΔMAPPEI = 15 ± 10 vs. 5 ± 5 mmHg, P = 0.001; ΔMSNAexercise = 17 ± 14 vs. 7 ± 9 bursts min–1, P = 0.04; ΔMSNAPEI = 14 ± 10 vs. 6 ± 4 bursts min–1, P = 0.04). Autonomic responses to exercise showed significant (P < 0.05) association with pro‐ (i.e. IFN‐γ, IL‐8, MCP‐1 and TNFα) and anti‐inflammatory (i.e. IL‐1ra and IL‐10) cytokines and with pain. In conclusion, post‐menopausal women with RA showed augmented pressor and sympathetic responses to exercise and to the activation of muscle metaboreflex. These findings provide mechanistic insights that may explain the abnormal cardiovascular responses to exercise in RA.

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Exercise therapy for improving cardiovascular health in rheumatoid arthritis

Coskun Benlidayi

2023

Rheumatol Int

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Chronotropic Incompetence and Reduced Heart Rate Recovery in Rheumatoid Arthritis

Abstract: Patients with RA showed reduced chronotropic response to exercise and slower postexercise HRR. These abnormal autonomic responses to exercise indicate the presence of cardiac autonomic dysfunction and increased cardiovascular risk in this population.

Cited by 9 publications

References 47 publications

The Interplay between Autonomic Nervous System and Inflammation across Systemic Autoimmune Diseases

The Interplay between Autonomic Nervous System and Inflammation across Systemic Autoimmune Diseases

Increased sympathetic and haemodynamic responses to exercise and muscle metaboreflex activation in post‐menopausal women with rheumatoid arthritis

Exercise therapy for improving cardiovascular health in rheumatoid arthritis

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