Evaluation of cardiac autonomic functions in myasthenia gravis

Kocabaş, Zehra Uysal; Kizilay, Ferah; Başarıcı, İbrahim; Uysal, Hilmi

doi:10.1080/01616412.2018.1446690

Cited by 12 publications

(25 citation statements)

References 29 publications

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“…Several previous studies have revealed sympathovagal imbalance in favor of sympathetic tone and decreased baroreflex in MG patients, which is in line with our results [ 13 , 38 , 46 ]. This sympathetic dominance could have resulted in significantly lower TFC values in MG patients than in the controls despite the decrease in the myocardial contractility parameters.…”

Section: Discussionsupporting

confidence: 93%

Cardiac Autonomic Dysfunction in Myasthenia Gravis and Relapsing-Remitting Multiple Sclerosis—A Pilot Study

Rzepiński¹,

Zawadka‐Kunikowska

Newton

et al. 2021

JCM

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This study assessed cardiac autonomic response to head-up tilt test (HUTT) in 23 myasthenia gravis (MG) and 23 relapsing-remitting multiple sclerosis (RRMS) patients compared to 30 healthy controls (HC). Task Force® Monitor was used to evaluate cardiac inotropy parameters, baroreflex sensitivity (BRS), heart rate (HRV), and blood pressure variability (BPV) during HUTT. MG patients were characterized by reduced BRS (p < 0.05), post-HUTT decrease in high-frequency component (p < 0.05) and increase in sympathovagal ratio of HRV (p < 0.05) when compared to controls indicating parasympathetic deficiency with a shift of sympathovagal balance toward sympathetic predominance. Compared to HC, MG patients also showed lower cardiac inotropy parameters, specifically, left ventricular work index (LVWI) during supine rest (p < 0.05) as well as LVWI and cardiac index values in response to orthostatic stress (p < 0.01 and p < 0.05, respectively). Compared to controls, RRMS patients were characterized by lower HRV delta power spectral density (p < 0.05) and delta low-frequency HRV (p < 0.05) in response to HUTT suggesting combined sympathetic and parasympathetic dysfunction. There were no differences in cardiac autonomic parameters between MG and MS patients (p > 0.05). Our study highlights the possibility of cardiac and autonomic dysfunction in patients with MG and RRMS which should be considered in the pharmacological and rehabilitation approach to managing these conditions.

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Section: Discussionsupporting

confidence: 93%

Cardiac Autonomic Dysfunction in Myasthenia Gravis and Relapsing-Remitting Multiple Sclerosis—A Pilot Study

Rzepiński¹,

Zawadka‐Kunikowska

Newton

et al. 2021

JCM

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“…In view of the risk of fatal cardiorespiratory arrest, simple HRV tests could be useful in COVID-19 patients for the sudden cardiac death risk. The disturbance in the baroreflex mechanism causes cardiac conduction abnormalities and the detection of an autonomic disorder via the evaluation of HRV and BRS using non-invasive methods in patients with COVID-19 could alert clinicians to possible patient morbidity and mortality (Kocabas et al, 2018). Prospective study needs are warranted to determine the value of autonomic testing and regimes for 4 https://www.ncbi.nlm.nih.gov/ (accessed March 19, 2021) 5 https://www.intechopen.com/books/subject/health-sciences (accessed March 19, 2021) 6 https://www.nemechekconsultativemedicine.com/vns-covid-19-white-paper/ (accessed March 19, 2021) the prevention and treatment of this complication of COVID-19 infection.…”

Section: Discussionmentioning

confidence: 99%

“…The study included all patients in a clinically stable condition that allowed testing using cardiovascular reflex tests. Patients with liver and renal disease; with systemic disease (e.g., connective tissue disorders); with a neurological disorder (e.g., cerebrovascular and Parkinson’s disease, Guillain–Barré syndrome, polyneuropathy, multiple sclerosis); with previously existing cardiac diseases (e.g., ischemic or congestive or valvular heart disease, cardiomyopathy, arrhythmia) ( Kocabas et al, 2018 ); patients with a malignancy; were excluded from the analysis. The 75 COVID-19 patients without associated diseases were divided into a severe group (45 patients with confirmed interstitial pneumonia, aged 51.27 ± 19.13, male 24, female 21) and mild group (30 patients, aged 41.56 ± 16.68, male 16, female 14 without pneumonia).…”

Section: Methodsmentioning

confidence: 99%

“…The ECG and blood pressure waveforms acquisition was performed by Task Force© Monitor (TFM), CNSystems Medizintechnik GmbH, Graz, Austria (CNS) ( Kocabas et al, 2018 ; CNSystems, 2020 ), which also provides beat-to-beat R–R interval (RRI) and its inverse hear rate (HR) time series, as well as beat-to-beat systolic and diastolic blood pressure (sBP, dBP) by the vascular unloading technique ( Gratze et al, 1998 ; Parati et al, 2003 ), which was corrected automatically to the oscillometric blood pressure measured on the contralateral arm ( Zawadka-Kunikowska et al, 2018 ).…”

Section: Methodsmentioning

confidence: 99%

“…The definition of orthostatic hypotension is as follows: SBP reduction greater than 20 mmHg or DBP reduction greater than 10 mmHg that follows a postural change from supine to standing. • The isometric contraction or handgrip test (HG): "A plastic ball with a medium level of firmness was placed in the right hand of the patient, and the patient was instructed to squeeze and release the ball for 15 s. Then, the patient was instructed to squeeze the ball with the right hand firmly and the test was ended at 1 min (Kocabas et al, 2018)." A rise in BP due to muscular contraction is related to an increase of sympathetic nerve activity at the muscular level.…”

Section: Cardiovascular Reflex Tests (Cart)mentioning

confidence: 99%

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Assessment of Autonomic Nervous System Dysfunction in the Early Phase of Infection With SARS-CoV-2 Virus

et al. 2021

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BackgroundWe are facing the outburst of coronavirus disease 2019 (COVID-19) defined as a serious, multisystem, disorder, including various neurological manifestations in its presentation. So far, autonomic dysfunction (AD) has not been reported in patients with COVID-19 infection.AimAssessment of AD in the early phase of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus).Patients and methodsWe analyzed 116 PCR positive COVID-19 patients. After the exclusion of 41 patients with associate diseases (CADG), partitioned to patients with diabetes mellitus, hypertension, and syncope, the remaining patients were included into a severe group (45 patients with confirmed interstitial pneumonia) and mild group (30 patients). Basic cardiovascular autonomic reflex tests (CART) were performed, followed by beat-to-beat heart rate variability (HRV) and systolic and diastolic blood pressure variability (BPV) analysis, along with baroreceptor sensitivity (BRS). Non-linear analysis of HRV was provided by Poincare Plot. Results were compared to 77 sex and age-matched controls.ResultsAD (sympathetic, parasympathetic, or both) in our study has been revealed in 51.5% of severe, 78.0% of mild COVID-19 patients, and the difference compared to healthy controls was significant (p = 0.018). Orthostatic hypotension has been established in 33.0% COVID-19 patients compared to 2.6% controls (p = 0.001). Most of the spectral parameters of HRV and BPV confirmed AD, most prominent in the severe COVID-19 group. BRS was significantly lower in all patients (severe, mild, CADG), indicating significant sudden cardiac death risk.ConclusionCardiovascular autonomic neuropathy should be taken into account in COVID-19 patients’ assessment. It can be an explanation for a variety of registered manifestations, enabling a comprehensive diagnostic approach and further treatment.

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