Altered diurnal cardiac sympathovagal balance correlates with nutritional status indexes in systemic sclerosis patients.

Autonomic nervous system is involved in body weight regulation. Gastrointestinal manifestations of systemic sclerosis (SSc) can influence patients’ nutritional status and facilitate the development of protein–energy malnutrition. The aim of the study is to assess the nutritional status of SSc patients and to explore its possible correlation with autonomic dysfunction using heart rate variability (HRV). We enrolled 19 SSc subjects and 19 healthy subjects as controls. Body mass index (BMI) and body surface area (BSA) were collected and recorded in all patients. HRV was measured and the domains of low frequencies (LF, index of the sympathetic modulation) and high frequencies (HF, index of the parasympathetic modulation) were recorded. As assessed by the LF/HF RATIO, sympathovagal balance is altered in SSc patients because of increased sympathetic modulation and reduced parasympathetic activity. BMI positively correlates with LF (r=0.57; p less than 0.01) and LF/HF RATIO during daytime (r= 0.46; p less than 0.05). Similarly, BSA positively correlates with LF (r= 0.51; p less than 0.05), LF day time (r= 0.53; p less than 0.05) and LF/HF RATIO night time (r=-0.51; p less than 0.05). In SSc patients the autonomic dysfunction is characterized by increased sympathetic modulation. We observed a correlation between autonomic dysfunction and nutritional status in SSc patients.

Body mass index is related to autonomic nervous system activity as measured by heart rate variability.

Autonomic nervous system activity is involved in body weight regulation. We assessed whether the body mass index (BMI) is related to the autonomic nervous system activity as assessed by heart rate variability (HRV). Twenty-five adult normotensive, euglycemic healthy males (M) and females (F) were studied (M/F=13/12). BMI was assessed in each individual. HRV was assessed and the domains of low frequencies (LF, index of the sympathetic modulation) and high frequencies (HF, index of the parasympathetic modulation) were measured. Data were statistically analyzed and are presented as mean+/-s.d. Mean BMI did not correlate with either HF or LF. It inversely related to HF (r=-0.50, P<0.01), whereas its relationship with LF was marginally significant (r=-0.39, P=0.05). The HF in individuals with BMI <20 kg/m(2) was significantly higher from those measured in the remaining subjects (P<0.05). The results support the role of parasympathetic activity in influencing BMI through likely modulation of body weight.

Sleep's quality disorders in patients with hypertension and type 2 diabetes mellitus.

Sleep is one of the most important factors contributing to health. Although same studies examining the relationship between sleep duration and mortality, has not been fully discussed. We consecutively studied two hundred and fifty Caucasian subjects, normoweight, who were referred for ambulatory blood pressure monitoring (APM). Quality of sleep was evaluated through the Pittsburgh Sleep Quality Index (PSQI). PSQI assessed subjective sleep quality of the past 4 weeks and was administered during the personal interview. A global PSQI > or =5 has a diagnostic sensitivity of 89.6 and specificity of 86.5 in distinguishing "poor sleepers"(PSQI > or =5) from "good sleepers" (PSQI <5) subjects. Hypertension, type 2 diabetes mellitus and sleep's quality disorders were reported respectively in 53.4%, 12.5% and 35.2% of the total population examined. The prevalence of hypertension was 87.1% in "poor sleepers" subjects versus 35.1% in "good sleepers" subjects (p<0.0001). Our results permit to conclude that, as the sleep-disordered breathing, also the sleep's quality disorders, evaluated by PSQI, are associated with significant comorbidities, as hypertension and diabetes mellitus. We hypothesize that the valuation of the quality of sleep through the Pittsburgh Sleep Quality Index (PSQI) could be considered in screening for cardiovascular risk.

Circadian rhythm of autonomic activity in non diabetic offsprings of type 2 diabetic patients.

UNLABELLED: The aim of the present study was to evaluate, by heart rate variability (HRV) with 24-hours ECG Holter (HRV), the circadian autonomic activity in offspring of type 2 diabetic subjects and the relation with insulin-resistance. METHODS: 50 Caucasian offsprings of type 2 diabetic subjects were divided in two groups: insulin-resistant offsprings (IR) and non insulin-resistant offsprings (NIR). Autonomic nervous activity was studied by HRV. Time domain and spectral analysis (low frequency, LF, and high frequency, HF, provide markers of sympathetic and parasympathetic modulation when assessed in normalized units) were evaluated. RESULTS: Time domain showed a reduction of total SDNN in IR (p < 0.001) and NIR (p 0.047) versus controls. Spectral analysis showed a total and night LF higher in IR and NIR than in control group (all p < 0.001). CONCLUSION: In frequency domain, the analysis of sympathetic (LF) and parasympathetic (HF) component evidenced an association between the offspring of type 2 diabetic subjects and a sympathetic overactivity. A global reduction and alteration of circadian rhythm of autonomic activity are present in offspring of type 2 diabetic patients with and without insulin resistance. The data of our study suggested that an autonomic impairment is associated with the familiarity for type 2 diabetes independently to insulin resistance and that an impairment of autonomic system activity could precede the insulin resistance.

Myocardial infarction with normal coronary arteries in a patient with primary antiphospholipid syndrome--case report and literature review.

Primary antiphospholipid syndrome is associated with an increased risk of vascular thrombosis. The authors describe a young patient without any risk factor for coronary artery disease who was admitted to the hospital because of a transient cerebral ischemic attack. Standard EKG showed signs of a previous silent inferior wall myocardial infarction, confirmed by echocardiography, technetium-99 scintigraphy, and left ventricular angiography. Coronary arteries appeared normal at angiography. Blood tests showed the presence of antiphospholipid antibodies and lupus anticoagulant. Since there is evidence that these antibodies are associated with an increased risk of microvascular thrombosis, the authors conclude that this silent myocardial infarction could be caused by a cardiac microvascular disease accompanying the antiphospholipid syndrome.

Activity of a nitroxylated analog of daunorubicin, ruboxyl, in B-lymphoproliferative disorders.

A nitroxylated analog of daunorubicin, ruboxyl (RBX), showed low toxicity but significant lympholytic effect in preclinical evaluations. A series of studies in vitro and in animals demonstrate that RBX is a putative agent in the treatment of many neoplasms. We report the results of a study in mice in which RBX showed selective B-lymphocyte immunosuppression. On the basis of this experience, RBX was administered to 3 patients with multiple myeloma and two patients with Waldenström's disease. The results of this pilot clinical study show that this compound has good activity and low myelotoxicity and cardiotoxicity, but seems to be characterized by a threatening immunosuppressive effect.

Assessment of echocardiographic abnormalities in patients with systemic lupus erythematosus: correlation with levels of antiphospholipid antibodies.

BACKGROUND: The aim of this study was to evaluate the incidence of morphologic and functional cardiac abnormalities in patients with systemic lupus erythematosus and correlate the data with antiphospholipid antibody (aPL) levels. METHODS: Ninety-one patients with systemic lupus erythematosus were enrolled and divided into two groups according to the presence (Group 1, n = 45) or absence of aPL (Group 2, n = 46). All patients underwent standard two-dimensional and Doppler echocardiographic examination. aPL were detected by a standardized and validated ELISA test. Five patients with regional ventricular dysfunction also underwent coronary angiography. The chi2 test was used for the statistical analysis of the data. For smaller groups of samples the Fisher's exact test was employed. RESULTS: Pericardial effusion was detected in 19 patients without any statistical difference between the two groups. A valvular involvement was present in 39 patients: a moderate-severe degree was more frequent in Group 1 (p = 0.02). Regional wall motion abnormalities were observed in 8 patients: only 1 in Group 2 and 7 in Group 1 (p = 0.03). Coronary angiography showed normal arteries in all patients of Group 1. CONCLUSIONS: aPL play a role in the pathogenesis of the severity of valvular lesions as well as in regional myocardial dysfunction, suggesting a small vessel disease.

Heart rate variability in Parkinson's disease patients treated with tolcapone.

Following the introduction of tolcapone, a potent, reversible Catechol-O-methyltransferase (COMT) inhibitor, it has been possible to optimise the management of Parkinson's disease (PD) patients in chronic Levodopa (L-dopa) therapy. The interaction between tolcapone and the endogenous metabolism of catecholamines points to a possible influence on autonomic cardiovascular function.Cardiovascular reflexes have been analysed in a group of seven PD patients (four males, three females; mean age 69.7years, mean disease duration 14.1years) by means of the heart rate variability (HRV) method using a continuous 24-h ECG (ECGD), before and after six months of treatment with tolcapone (in addition to L-dopa).We have observed no statistically significant differences in HRV parameters, nor any changes in the incidence of hyperkinetic and hypokinetic arrhythmias, which suggest that autonomic cardiovascular function in PD patients is not influenced by six months of treatment with tolcapone.

Technetium-99m sestamibi single-photon emission tomography detects subclinical myocardial perfusion abnormalities in patients with systemic lupus erythematosus.

In patients with systemic lupus erythematosus, involvement of the cardiovascular system is the third leading cause of death. However, although autopsy studies have demonstrated a high incidence of abnormalities in both the myocardium and coronary vessels, clinical manifestations have been reported in only a small percentage of cases. The aim of this study was to evaluate myocardial perfusion in asymptomatic lupus patients using technetium-99m sestamibi single-photon emission tomography (SPET). Twenty-eight patients without overt cardiac involvement and risk factors were studied with 99mTc-sestamibi SPET at rest and after dipyridamole infusion. Perfusion abnormalities were detected in 18 cases: six had persistent defects, three had reversible defects, seven had both persistent and reversible defects, and two showed rest defects which normalized on dipyridamole images ("reverse redistribution pattern"). Coronary angiography was performed in eight patients with positive 99mTc-sestamibi SPET, and showed normal epicardial vessels in all the cases. These results indicate that 99mTc-sestamibi SPET reveals a high prevalence (18 out of 28 patients in this study, i.e. 64%) of myocardial perfusion abnormalities in asymptomatic lupus patients, probably due to the primary immunological damage of this autoimmune disease. In conclusion, rest/dipyridamole 99mTc-sestamibi SPET can be a useful non-invasive method to identify subclinical myocardial involvement in systemic lupus erythematosus, and patients potentially at risk of later cardiac events.

Twenty-four-hour heart rate variability to assess autonomic function in Parkinson's disease.

OBJECTIVES: To evaluate the autonomic dysfunction in Parkinson's disease patients by means of a 24-h heart rate variability (HRV) method. MATERIAL AND METHODS: Thirteen patients with a diagnosis of Parkinson's disease were compared with 13 age-matched healthy persons (control group). The 13 patients had a mean age of 70.5 years, and mean disease duration of 10.9 years. The autonomic function was evaluated by HRV analysis using a continuous 24-h ECG. The parameters of SDNN (standard deviation of the normal-to-normal intervals between adjacent QRS complexes), of LF (power in low frequency) and of HF (power in high frequency) were studied during the following 3 periods: 24 h, night and day. RESULTS: The data show a statistically significant difference between groups for SDNN and LF in all the periods, while for HF parameters the difference is statistically significant only in the night period. CONCLUSION: The use of the 24-h HRV method can provide more accurate and reproducible data than other conventional cardiovascular tests.

Lupus carditis: evaluation with technetium-99m MIBI myocardial SPECT and heart rate variability.

The objective of this paper was to investigate the incidence of myocardial perfusion defects in patients with systemic lupus erythematosus (SLE) associated with dysautonomic alterations. Twenty patients without any sign or symptoms of heart disease, selected from a larger population of patients with SLE, underwent technetium-99m sestamibi (Tc-99m MIBI) single photon emission computed tomography (SPECT), at rest and after dipyridamole infusion; they also underwent heart rate variability (HRV) examination by a 24 hour ambulatory electrocardiography, analyzing in the time domain the standard deviation of the R-R intervals average (SDNN) and the percentage of R-R adjacent intervals differing from each other more than 50 msec (pNN50); in the frequency domain the low (LF) and high frequencies (HF) were analyzed. Twenty healthy volunteers served as control group for heart rate variability. At MIBI-SPECT examination, the scan was found abnormal in 15 patients and normal in five: three patients demonstrated reversible defects in the anteroseptal region, four had irreversible defects in a region (two in the anteroseptal region and two in the lateral region), two had rest defects in two different regions (lateral and inferior, lateral and anteroseptal) that improved during dipyridamole scan, and six had both reversible and irreversible defects: four in a single segment (three anteroseptal and one lateral, and two in two different regions, particularly anteroseptal and lateral, lateral and inferior). All 20 patients showed significantly lower HRV parameters in comparison with the control group, except for pNN50, which indicates decreased physiologic periodic fluctuations of the autonomic nervous system. In six patients who underwent coronary angiography, the epicardial vessels were found completely normal. In view of the high incidence of myocardial hypoperfusion in patients with HRV alterations, the authors hypothesize that autonomic dysfunction may be associated with microvascular disease or metabolic alteration. They also believe that MIBI scintigraphy is a suitable technique in detecting myocardial damage in SLE patients free of clinical manifestation.

[The role and chronobiometric study of ambulatory arterial pressure monitoring in hypertensive patients with a recent cerebral ischemia episode]. / Ruolo e studio cronobiometrico del monitoraggio ambulatoriale della pressione arteriosa in pazienti ipertesi con recente episodio ischemico cerebrale.

Essential hypertensive patients with a history of recent TIA syndrome were investigated by ambulatory blood pressure monitoring (ABPM). The aim of this trial was to verify the presence of false normotensive patients in order to optimize the secondary prevention of hypertensive cerebrovascular damage (ischemic or hemorrhagic stroke). This study was carried out on 51 patients (26 M and 25 F, mean age = 58 +/- 14 yrs) and 225 clinically healthy control subjects (113 M and 112 F, mean age = 55 +/- 12 yrs), who underwent an ABPM. The BP time series were analyzed by chronobiometric procedures. The comparison of the individual BP within-day values to the reference limit revealed a highly significant proportion of these patients (90%) whose hypertension was not well controlled. Their BP series showed supranormal values ranging from 39% to 56% of all the readings, with a pressure excess ranging from 8.35 h to 11.34 h. The high incidence of not adequately treated patients with a history of recent TIA syndrome confirms that their hypertension should be controlled by means of the ABPM. These results suggest that the chronomodulation of the antihypertensive treatment might be the better management of BP regimen in these patients for the secondary prevention of cerebrovascular damage.

[Heart and autonomic nervous system in connective tissue disorders]. / Cuore e sistema nervoso autonomo nelle connettiviti.

UNLABELLED: Heart rate variability (HRV) is a suitable diagnostic tool in identifying patients with autonomic nervous system (ANS) disorders even in pre-clinical stage. We have enrolled in this study all patients with large variety of connective tissue disorders, given the possibility of an involvement of ANS in these diseases. The study population consisted in eighty-five patients (68 females and 17 males), 35 of whom affected by systemic lupus erythematosus, 16 by rheumatoid arthritis, 14 by Sjögren syndrome, 12 by progressive systemic sclerosis, 3 by Behçet syndrome and 5 by antiphospholipid antibodies syndrome. The mean age ranged between 33.7 of patients with lupus erythematosus and 51.8 of those with Sjögren syndrome. As control, we enrolled healthy subjects of different age, divided into two groups, to rule out the aging as potential source of considered parameters alteration. The autonomic function has been evaluated by 24 hours ambulatory monitoring, using a Zymed 1210 Scanner with Zymed 3.74-PC 1990 software. We have considered: in the time domain, the standard deviation of the RR intervals average (SDNN) and the percentage of RR adjacent intervals differing each other more than 50 msec (pNN50); in the frequency domain, the low (LF) and high (HF) frequencies, the LF/HF ratio, and the total power (RT). The HRV parameters resulted abnormal in every type of the connective tissue diseases considered: particularly SDNN, pNN50, LF, HF and RT (p < or = 0.01). IN CONCLUSION: the results of our study suggest that autonomic neuropathy may be present in any kind of connective tissue disorders even in preclinical stage.

[Arrhythmias in the aged: prevalence and correlation with symptoms]. / Le aritmie nell'anziano: prevalenza e correlazione con la sintomatologia.

Objective of our study was to evaluate the prevalence of arrhythmias as well as their correlation with the reported anamnestic symptomatology in the elderly population. With 24 hour ambulatory electrocardiography (Holter ECG) 913 patients, (440 males and 473 females, range 60-89 years, mean age 71) were consecutively studied and subdivided according to the following criteria: (1) age (3 classes: 60-69 [I], 70-79 [II], > or = 80 [III]; (2) presence/absence of "guide" symptoms (syncope/faintness, chest pain, palpitation), and (3) Holter electrocardiography results. We have demonstrated a high prevalence of arrhythmias: 72% (657), which was significantly higher in age classes II (80.5%) and III (79.1%) in comparison to class I (60.6%). A notably higher prevalence of tachyarrhythmias is documented compared to bradyarrhythmias (5:1). With a higher age the prevalence of supraventricular tachyarrhythmias increases significantly, while bradyarrhythmias do not have the same trend. We have a similar prevalence of arrhythmias between symptomatic (77.4%) and asymptomatic patients (63.6%) and no significant correlation between anamnestic symptoms and presence of arrhythmias are observed. Considering the high prevalence of arrhythmias during Holter ECG we think that the clinical importance and prognosis should be evaluated with caution.

Heart rate variability and cardiac autonomic function in systemic lupus erythematosus.

The cardiac autonomic function was evaluated in 23 patients with Systemic Lupus Erythematosus (SLE) without clinical expression of dysautonomia and in 14 healthy volunteer subjects as a control group, by analysis of Heart Rate Variability (HRV) from 24h ambulatory electrocardiography. All the patients were taking corticosteroids and 10 of them also Ciclosporin A (CsA). The following parameters of HRV were performed: Time domain: standard deviation of the RR intervals average (SDNN) and percentage of RR adjacent intervals differing from each other more than 50 msec (pNN50). Frequency domain: low frequencies (LF) and high frequencies (HF). Significant lower values were detected in SLE patients vs controls: SDNN = 69.40 vs 127.72; pNN50 = 16.44 vs 25.95; LF = 8.34 vs 34.97; HF = 3.21 vs 12.18. The incidence of autonomic dysfunction in our SLE population evaluated by considering intervals of normality is approximately 78% for SDNN; 17% for pNN50; 91% for LF and, finally, 56% for HF. The analysis of HRV may be a valuable technique in the study of the incidence of dysautonomia for these patients.