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Cardiac autonomic modulation at rest and during orthostatic stress among different systemic sclerosis subsets

  • Gabriel Dias Rodrigues
    Affiliations
    Department of Physiology and Pharmacology, Biomedical Institute, Fluminense Federal University, Niterói, Brazil

    National Institute for Science & Technology - INCT (In)activity & Exercise, CNPq, Niterói, (RJ) Rio de Janeiro, Brazil
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  • Eleonora Tobaldini
    Affiliations
    Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy

    Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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  • Chiara Bellocchi
    Affiliations
    Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
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  • Alessandro Santaniello
    Affiliations
    Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
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  • Monica Caronni
    Affiliations
    Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
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  • Adriana Severino
    Affiliations
    Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
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  • Marco Froldi
    Affiliations
    Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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  • Lorenzo Beretta
    Affiliations
    Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
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  • Pedro Paulo da Silva Soares
    Affiliations
    Department of Physiology and Pharmacology, Biomedical Institute, Fluminense Federal University, Niterói, Brazil

    National Institute for Science & Technology - INCT (In)activity & Exercise, CNPq, Niterói, (RJ) Rio de Janeiro, Brazil
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  • Author Footnotes
    1 IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy.
    Nicola Montano
    Correspondence
    Corresponding author at: Department of Internal Medicine, Fondazione IRCSS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy.
    Footnotes
    1 IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy.
    Affiliations
    Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy

    Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
    Search for articles by this author
  • Author Footnotes
    1 IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy.

      Highlights

      • Linear and nonlinear heart rate variability is impaired in Systemic Sclerosis.
      • Systemic Sclerosis patients have a blunted autonomic response to orthostatic stress.
      • Autonomic impairment occurs during the fibro-vascular progression of the disease.
      • Heart rate variability is not an early maker of dysfunction in this population.

      Abstract

      Objective

      To compare autonomic heart rate variability (HRV) parameters at rest and during active stand in a population of SSc patients, taking into account SSc subsets age-matched to healthy control subjects.

      Methods

      Sixty-nine consecutive SSc patients were enrolled in study; these included 12 subjects with early SSc, 39 with limited cutaneous (lcSSc) and 18 with diffuse cutaneous SSc (dcSSc) along with 36 age- and sex-matched healthy controls (HC). ECG and respiration were recorded in supine position and in orthostatism (ORT). HRV analysis was performed on samples of 300 beats. Spectral analysis identified two oscillatory components, low frequency (LFnu, sympathetic) and high frequency (HFnu, vagal). Symbolic analysis identified three patterns, 0 V%, (sympathetic) and 2UV% and 2LV%, (vagal). The %∆ORT was calculated from the differences between HRV in ORT and SUP, normalized (%) by the HRV values at rest.

      Results

      SSc as a whole had higher markers of sympathetic (LF, 0 V%) and lower markers of vagal modulation (HR, 2UV%, 2LV%) compared to HCs. In addition, %∆LFnu, %∆HFnu, %∆0 V, %∆2UV and %∆2LV were lower in SSc than HC. dcSSc and lcSSc were dissimilar to HC as far as rest indexes were concerned (↑LF/HF, ↑LFnu, ↓HFnu, ↑0 V% and ↓2UV%) while no differences could be detected between HC and EaSSc.

      Conclusion

      SSc showed a reduced vagal and increased sympathetic modulation at rest and a blunted autonomic response to ORT in comparison to HC. These alterations were mostly detectable in the advanced and fibrotic forms of SSc (dcSSc and lcSSc), while EaSSc were similar to HC.

      Key-words

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