Autonomic nervous system dysfunction correlates with microvascular damage in systemic sclerosis patients.

Area of Science:

• Rheumatology
• Cardiology
• Neurology

Background:

• Cardiac autonomic neuropathy (CAN) is a significant cardiovascular complication in systemic sclerosis (SSc).
• CAN can negatively impact the overall prognosis of SSc patients.
• Understanding CAN prevalence and its associations is crucial for managing SSc.

Purpose of the Study:

• To determine the prevalence of cardiac autonomic neuropathy (CAN) in a cohort of systemic sclerosis (SSc) patients.
• To investigate the association between CAN and clinical/epidemiological data, focusing on microvascular damage severity.
• To compare features of CAN with nailfold videocapillaroscopy findings in SSc.

Main Methods:

• Enrolled 26 patients with definite systemic sclerosis.
• Conducted physical examinations, nailfold videocapillaroscopy (NVC), and autonomic neuropathy tests.
• Utilized orthostatic hypotension, deep breathing, lying-to-standing, and Valsalva maneuvers for diagnosis.

Main Results:

• Cardiac autonomic neuropathy (CAN) was present in 50% of the SSc patients (13 cases).
• CAN showed a significant association with active patterns on nailfold videocapillaroscopy (NVC) (OR 5.86, p=0.032).
• Multivariate analysis confirmed independent associations of CAN with active NVC patterns (OR 7.19, p=0.042) and anti-Scl-70 positivity (OR 5.92, p=0.048).

Conclusions:

• Severe microvascular damage detected by nailfold videocapillaroscopy (NVC) may indicate coexisting autonomic dysfunction.
• NVC findings should serve as a warning sign for identifying SSc patients at higher risk of cardiac issues.
• Early identification of CAN through NVC can aid in managing cardiac morbidity and mortality in SSc.