Impairment of cardiac autonomic control in patients with amyotrophic lateral sclerosis

Abstract

The aim of this study was to investigate autonomic cardiac control in patients with amyotrophic lateral sclerosis (ALS). Fifty-five patients with sporadic ALS (28 female and 27 male; average age 56.00 +/- 10.34 years) were compared to 30 healthy controls (17 female and 13 male; average age 42.87 +/- 11.91 years). Patients with previous history of cardiac disease, diabetes mellitus, and impaired respiratory function were excluded from the study. Cardiovascular autonomic tests according to Ewing, power spectrum analysis of RR variability (low- and high-frequency bands - LF and HF, LF/HF index), real-time beat-to-beat ECG signal monitoring with heart rate variability analysis and baroreflex function analysis were carried out in all patients. Time-domain parameters of heart rate variability (mean RR interval, SDNN, SDANN, SDNN index, rMSSD and pNN50%) were obtained from 24-h ECG monitoring. ALS patients had a significantly higher score of sympathetic (p <0.01) and parasympathetic (p <0.001) dysfunction, as well as of the overall score of autonomic dysfunction (p <0.001). LF/HF index was significantly increased; baroreflex sensitivity and time-domain parameters of heart rate variability were highly significantly decreased in ALS patients (p <0.001). Our results demonstrated impaired cardiac autonomic control in ALS with marked parasympathetic dysfunction and sympathetic predominance.

Crowdsourced analysis of clinical trial data to predict amyotrophic lateral sclerosis progression

“…Further features of interest include creatine kinase, whose levels highly correlate with creatinine levels, suggested to be predictive of prognosis in ALS 42,43 . Pulse and blood pressure, which at first glance may be surprising predictive features for ALS, are supported by a body of literature suggesting sympathetic dysfunction in ALS [44][45][46][47] . Further research and studies are needed to assess the potential of these features and elucidate their involvement in ALS pathophysiology.…”

Cardiac autonomic control in patients with myasthenia gravis and thymoma

“…Reduced HRV and increased sympathetic tone are known to predispose to arrhythmogenesis [17,19]. They are also identified as mortality risk factors in patients with cardiac diseases and in patients with diabetic autonomic neuropathy [10]. Thus, autonomic impairment may also significantly influence disease prognosis in patients with MG and thymoma and investigations of autonomic nervous system may be of major importance in these subjects.…”

“…Autonomic impairment has been shown to affect disease prognosis in many neurological disorders [10][11][12][13]. Therefore it merits early detection.…”

Can amyotrophic lateral sclerosis chronically elevate troponin T?

“…Although there was little clinical information to suggest concomitant cardiovascular disease, we cannot exclude the possibility that this patient had clinically occult cardiac involvement either due to ALS or due to some other cardiovascular abnormality and she certainly had risk factors for the latter which would provide the most parsimonious explanation for the cTnT elevations [6]. However, because it has now been shown that elevations in the cTnT assay can occur due to proteins that exist in skeletal muscle after injury [7], it may be that the elevations we observed were due to ALS alone.…”