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Heart Rate Variability as an Indicator of Autonomic Nervous System Disturbance in Behcet's Disease
Imtinene Ben Mrad1, Melek Ben Mrad2, Bouthaina Besbes1
1Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia.
Insights
Behçet's disease patients show reduced parasympathetic activity, impacting cardiac autonomic function. Heart rate variability (HRV) analysis reveals preserved circadian rhythms, suggesting HRV as a tool for monitoring Behçet's disease patients.
Area of Science:
- Cardiology
- Neurology
- Rheumatology
Background:
- Behçet's disease (BD) is a multisystemic vasculitis with potential cardiac implications.
- Increased incidence of ventricular arrhythmia and sudden cardiac death (SCD) in BD patients suggests autonomic nervous system (ANS) dysfunction.
- Previous studies on ANS function in BD have yielded controversial results.
Purpose of the Study:
- To assess cardiac autonomic function using heart rate variability (HRV) in BD patients.
- To evaluate circadian changes in HRV within the BD cohort.
- To investigate the relationship between HRV parameters and BD disease activity.
Main Methods:
- Heart rate variability (HRV) analyses were conducted in time and frequency domains over 24-hour, daytime, and nighttime periods.
- Thirty-six BD patients and 36 age/sex-matched healthy controls were included.
- Behçet's disease current activity form (BDCAF) assessed disease activity.
Main Results:
- BD patients exhibited significantly lower SDNN, PNN50, RMSSD, and HF components, indicating parasympathetic impairment.
- The LF/HF ratio was significantly higher in BD patients, while LF remained comparable.
- Circadian rhythms of HRV were preserved in BD patients, with no significant correlation between CRP or disease duration and HRV indices. BDCAF score negatively correlated with LF/HF.
Conclusions:
- Behçet's disease patients demonstrate reduced parasympathetic activity compared to controls, despite the absence of overt cardiovascular involvement.
- Circadian rhythms of autonomic function are maintained in BD patients.
- HRV serves as a practical tool for monitoring autonomic function in BD patients, potentially aiding in the understanding of arrhythmia pathogenesis.
Background:
Behçet's disease (BD) is a multisystemic vasculiti where cardiac involvement is not common. Previous studies have shown that the incidence of ventricular arrhythmia and sudden cardiac death (SCD) is higher in patients with BD than in the healthy population. Among various possible explanations, autonomic nervous system (ANS) dysfunction has been suggested. Few studies have evaluated ANS function in patients with BD, and the results obtained are controversial.
Objective:
We aimed to assess cardiac autonomic function by heart rate variability (HRV) in patients with BD; to evaluate circadian changes in HRV; and to study the relationship between HRV parameters and disease parameters.
Methods:
Thirty-six patients with Behçet's disease (median age 42 years, 28 men) and 36 age- and sex-matched healthy volunteers were included. HRV analyses were performed in the time and frequency domains for the entire 24-hour period and for the daytime and nighttime periods. BD activity was studied with Behcet's disease current activity form (BDCAF).
Results:
Patients with BD had significantly lower values of SDNN compared to controls. PNN50, RMSSD, and HF components mean values were significantly reduced in patients than in controls implying parasympathetic impairment. LF was comparable between the two groups, whereas LF/HF ratio was significantly higher in BD group. The circadian rhythm of HRV was preserved in patient group. There was no significant correlation of CRP or disease duration with HRV indices in Behçet's subjects. BDCAF score was found to be negatively correlated with LF/HF.
Conclusion:
Patients with BD, despite no cardiovascular involvement, have reduced parasympathetic activity compared with controls. However, circadian rhythms of autonomic function were preserved. As known, there is strong evidence for the role of the ANS in the pathogenesis of ventricular arrhythmias. Thus, being a practical tool, HRV can be an interesting approach for the rhythmic follow-up of BD patients.
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