The use of heart rate turbulence and heart rate variability in the assessment of autonomic regulation and circadian rhythm in patients with systemic lupus erythematosus without apparent heart disease

Poliwczak, Adam Rafał; Waszczykowska, Elżbieta; Dziankowska‐Bartkowiak, Bożena; Koziróg, Marzena; Dworniak, Katarzyna

doi:10.1177/0961203317725590

Cited by 14 publications

(12 citation statements)

References 33 publications

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“…compared 26 patients with SLE and 30 healthy subjects (age, sex and basic anthropometric parameters-matched) using 24-hour ambulatory ECG monitoring. 26 HRV and HRT analyses were performed for the entire day, and also separately for daytime activity (between 08:00 and 12:00) and night time rest (between 24:00 and 04:00). In the 24-hour analysis, most of the HRV parameters were significantly lower in the SLE patients when compared with the controls.…”

Section: Resultsmentioning

confidence: 99%

“…HRV: heart rate variability; NN: normal-to-normal; PNS: parasympathetic nervous system; PVC: premature ventricular contraction; SNS: sympathetic nervous system. 13,19,49 26 HRV and HRT analyses were performed for the entire day, and also separately for daytime activity (between 08:00 and 12:00) and night time rest (between 24:00 and 04:00). In the 24-hour analysis, most of the HRV parameters were significantly lower in the SLE patients when compared with the controls.…”

Section: Resultsmentioning

confidence: 99%

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Heart rate variability in patients with systemic lupus erythematosus: a systematic review and methodological considerations

Matusik

Stein²

2018

Lupus

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Aim The aim of this review was to summarize current knowledge about the scientific findings and potential clinical utility of heart rate variability measures in patients with systemic lupus erythematosus. Methods PubMed, Embase and Scopus databases were searched for the terms associated with systemic lupus erythematosus and heart rate variability, including controlled vocabulary, when appropriate. Articles published in English and available in full text were considered. Finally, 11 publications were selected, according to the systematic review protocol and were analyzed. Results In general, heart rate variability, measured in the time and frequency domains, was reported to be decreased in patients with systemic lupus erythematosus compared with controls. In some systemic lupus erythematosus studies, heart rate variability was found to correlate with inflammatory markers and albumin levels. A novel heart rate variability measure, heart rate turbulence onset, was shown to be increased, while heart rate turbulence slope was decreased in systemic lupus erythematosus patients. Reports of associations of changes in heart rate variability parameters with increasing systemic lupus erythematosus activity were inconsistent, showing decreasing heart rate variability or no relationship. However, the low/high frequency ratio was, in some studies, reported to increase with increasing disease activity or to be inversely correlated with albumin levels. Conclusions Patients with systemic lupus erythematosus have abnormal heart rate variability, which reflects cardiac autonomic dysfunction and may be related to inflammatory cytokines but not necessarily to disease activity. Thus measurement of heart rate variability could be a useful clinical tool for monitoring autonomic dysfunction in systemic lupus erythematosus, and may potentially provide prognostic information.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Heart rate variability in patients with systemic lupus erythematosus: a systematic review and methodological considerations

Matusik

Stein²

2018

Lupus

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“…They concluded that the patients with RA and SLE have marked autonomic dysfunction with sympathetic predominance in the patients with SLE and parasympathetic predominance in the patients with RA. Poliwczak et al 23 reported heart rate turbulence and HRV results of their adult patients with SLE without apparent heart disease. Their study confirmed the presence of autonomic disorders with respect to both HRV and heart rate turbulence parameters and the presence of diurnal disturbances of sympathetic-parasympathetic balance.…”

Section: Discussionmentioning

confidence: 99%

Heart rate variability in juvenile systemic lupus erythematosus patients

Başaran¹,

Çetin²,

Aydın³

et al. 2019

Turk J Pediatr

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Although neurological involvement has been well recognized in patients with systemic lupus erythematosus (SLE), autonomic nervous system (ANS) involvement has rarely been studied, and has shown conflicting results. The aim of this study was to evaluate the ANS functions by using heart rate variability (HRV) in juvenile patients with SLE. Sixteen juvenile-onset SLE patients and 16 healthy controls were enrolled in the study. All participants underwent 24-hour Holter electrocardiogram monitoring and HRV indices were assessed. The SLE disease activity index (SLEDAI) score was used to assess the disease activity. We analyzed the correlation between disease duration, the SLEDAI score, and the HRV domains. Overall HRV was diminished in patients with SLE compared to controls. There were negative correlations between day and night RMSSD (root-mean-square of the successive normal sinus NN interval differences) and PNN50 (percentage of successive normal sinus NN intervals >50 ms) values, and SLEDAI (r=-0.588 p=0.017; r=-0.607 p= 0.013; r=-0.498 p=0.049; r=-0.597 p=0.015, respectively). There were positive correlations between both day and night LF/HF values and SLEDAI (r=0.766 p=0.001; r=0.635 p=0.008, respectively). The results suggest that autonomic dysfunction exists in juvenile patients with SLE. As these children are at increased risk for cardiovascular disease, they need to be assessed for the development of autonomic dysfunction.

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“…In addition, the observed changes in HRV under different conditions are often less than 20% (Buccelletti et al, 2009; Pieters et al, 2012). Given the overlap in HRV values between normal and altered physiological states (Rajendra Acharya et al, 2006; Benichou et al, 2018; Poliwczak et al, 2018), our proposed data exclusion method is likely to be applicable to most physiological/pathological conditions. Furthermore, our results showed that % change exclusion criterion is a feasible way for analyzing long-term recordings, providing a basis for future studies looking at pathological conditions.…”

Section: Discussionmentioning

confidence: 99%

The Use of Percent Change in RR Interval for Data Exclusion in Analyzing 24-h Time Domain Heart Rate Variability in Rodents

et al. 2019

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While epidemiological data support the link between reduced heart rate variability (HRV) and a multitude of pathologies, the mechanisms underlying changes in HRV and disease progression are poorly understood. Even though we have numerous rodent models of disease for mechanistic studies, not being able to reliably measure HRV in conscious, freely moving rodents has hindered our ability to extrapolate the role of HRV in the progression from normal physiology to pathology. The sheer number of heart beats per day (>800,000 in mice) makes data exclusion both time consuming and daunting. We sought to evaluate an RR interval exclusion method based on percent (%) change of adjacent RR intervals. Two approaches were evaluated: % change from “either” and “both” adjacent RR intervals. The data exclusion method based on standard deviation (SD) was also evaluated for comparison. Receiver operating characteristic (ROC) curves were generated to determine the performance of each method. Results showed that exclusion based on % change from “either” adjacent RR intervals was the most accurate method in identifying normal and abnormal RR intervals, with an overall accuracy of 0.92–0.99. As the exclusion value increased (% change or SD), the sensitivity (correctly including normal RR intervals) increased exponentially while the specificity (correctly rejecting abnormal RR intervals) decreased linearly. Compared to the SD method, the “either” approach had a steeper rise in sensitivity and a more gradual decrease in specificity. The intersection of sensitivity and specificity where the exclusion criterion had the same accuracy in identifying normal and abnormal RR intervals was 10–20% change for the “either” approach and ∼ 1 SD for the SD-based exclusion method. Graphically (tachogram and Lorenz plot), 20% change from either adjacent RR interval resembled the data after manual exclusion. Finally, overall (SDNN) and short-term (rMSSD) indices of HRV generated using 20% change from “either” adjacent RR intervals as the exclusion criterion were closer to the manual exclusion method with lower subject-to-subject variability than those generated using the 2 SD exclusion criterion. Thus, 20% change from “either” adjacent RR intervals is a good criterion for data exclusion for reliable 24-h time domain HRV analysis in rodents.

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The use of heart rate turbulence and heart rate variability in the assessment of autonomic regulation and circadian rhythm in patients with systemic lupus erythematosus without apparent heart disease

Abstract: Our study confirms the presence of autonomic disorders with respect to both heart rate variability and heart rate turbulence parameters and the presence of diurnal disturbances of sympathetic-parasympathetic balance. Further studies are required.

Cited by 14 publications

References 33 publications

Heart rate variability in patients with systemic lupus erythematosus: a systematic review and methodological considerations

Heart rate variability in patients with systemic lupus erythematosus: a systematic review and methodological considerations

Heart rate variability in juvenile systemic lupus erythematosus patients

The Use of Percent Change in RR Interval for Data Exclusion in Analyzing 24-h Time Domain Heart Rate Variability in Rodents

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