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Cardiovascular autonomic neuropathy in rheumatoid arthritis assessed by cardiovascular autonomic function tests: A cross-sectional survey [Anatol J Cardiol]
Anatol J Cardiol. 2015; 15(9): 722-726 | DOI: 10.5152/akd.2014.5635  

Cardiovascular autonomic neuropathy in rheumatoid arthritis assessed by cardiovascular autonomic function tests: A cross-sectional survey

Zahra Javady Nejad1, Ahmad Reza Jamshidi2, Mostafa Qorbani3, Pooneh Ravanasa4
1Department of Cardiology, Baharlou Hospital, Tehran University of Medical Sciences; Tehran-Iran
2Department of Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences; Tehran-Iran
3Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences; Karaj-Iran
4Biomedical of Engineering, Islamic Azad University; Tehran-Iran

Objective: In this study, we aimed to evaluate cardiovascular autonomic neuropathy (CAN) in RA patients by cardiovascular autonomic function tests. Because CAN was reported of patients with automimmune rheumatic diseases those may in sudden death or myocardial infarction. Methods: A total of 44 patients with RA and 44 age- and sex-matched healthy volunteers participated in this cross-sectional study. Assessment of CAN was performed using cardiovascular reflex tests. These five tests were: 1) beat-to-beat heart rate variation during deep breathing; 2) heart rate response to standing up; 3) heart rate response to the Valsalva maneuver; 4) blood pressure response to standing up; and 5) blood pressure response to sustained handgrip. Results: The mean age was 43.15 (SD, 12.18) years (range, 23-68 years) in the RA group, and 38 were women. In beat-to-beat heart rate variation during deep breathing, expiration-to-inspiration ratio was abnormal in 3 cases with RA (6.8%) but in 1 (2.3%) control subject (p=0.3), and maximum minus minimum heart rate was abnormal in 8 patients (18.2%) and in 3 (6.8%) control subjects (p=0.1). 2) In heart rate response to standing up, all patients and controls had normal results. Valsalva ratio was abnormal in 7 RA patients (15.9%) and in 7 control subjects (15.9%). Blood pressure response to standing up was normal in RA patients but abnormal in 1 (2.3%) control subject (p=0.4). Blood pressure response to sustained handgrip was abnormal in 5 RA patients (11.4%) and 2 (4.6%) control subjects (p=0.2). Conclusion: Our study failed to show any statistically significant difference between cardiovascular autonomic function tests in RA patients with control subjects by our test done.

Keywords: rheumatoid arthritis, cardiovascular autonomic neuropathy, cardiovascular autonomic function tests


Romatoid artritte kardiyovasküler otonom fonksiyon testleri ile değerlendirilen kardiyovasküler otonom nöropati, bir kesitsel araştırma

Zahra Javady Nejad1, Ahmad Reza Jamshidi2, Mostafa Qorbani3, Pooneh Ravanasa4
1Department of Cardiology, Baharlou Hospital, Tehran University of Medical Sciences; Tehran-Iran
2Department of Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences; Tehran-Iran
3Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences; Karaj-Iran
4Biomedical of Engineering, Islamic Azad University; Tehran-Iran

Amaç: Bu çalışmada kardiyovasküler otonom fonksiyon testleri ile RA hastalarında kardiyovasküler otonom nöropati (KON)’yi değerlendirmeyi amaçladık. Yöntemler: RA'lı 44 hasta ve yaş ve cinsiyet açısından eşleştirilmiş 44 sağlıklı gönüllü bu kesitsel çalışmaya katıldı. KON değerlendirmesi kardiyovasküler refleks testleri kullanılarak yapıldı. Bu beş test şunlardı: 1) derin solunum sırasında kalp atım hızında değişim; 2) ayağa kalkmaya kalp hızı yanıtı; 3) Valsalva manevrasına kalp hızı yanıtı; 4) ayağa kalkmaya kan basıncı yanıtı; 5) Sürekli el sıkma yayına (handgrip) kan basıncı yanıtı. Bulgular: RA grubunda ortalama yaş 43,15 (SD, 12,18) yıl (aralık, 23-68 yıl) ve 38’i kadındı. KON testlerinin değerlendirilmesi: 1) Derin solunum sırasında kalp atım hızında değişim: [a): Ekspirasyon/İnspirasyon oranı: E/İ oranı, RA olan hastalarda 3 olguda (%6,8) ancak kontrol olanlarda bir kişide (%2,3) anormal sonuçlandı (p=0,3). b): Maksimum eksi minimum kalp hızı: Bu test 8 hastada (%18,2) ve 3 kontrolde (%6,8) anormaldi (p=0,1)]. 2) Ayağa kalkmaya kalp hızı yanıtı: Tüm hasta ve kontrollerin sonucu normaldi. 3) Valsalva oranı: 7 RA hastasında (%15,9) ve 7 kontrolde (%15,9) anormaldi. 4) Ayağa kalkmaya kan basıncı yanıtı: RA hastalarında normaldi ancak bir (%2,3) kontrolde (p=0,4) anormaldi. 5) Sürekli el sıkma yayına kan basıncı yanıtı: 5 RA hastasında (%11,4) ve 2 (%4,6) kontrolde anormaldi (p=0,2). Sonuç: Çalışmamız kontrol grubu ile RA hastalarında kardiyovasküler otonom fonksiyon testleri arasında istatistiksel olarak anlamlı bir fark gösteremedi.

Anahtar Kelimeler: romatoid artrit, kardiyovasküler otonom nöropati, kardiyovasküler otonom fonksiyon testleri


Zahra Javady Nejad, Ahmad Reza Jamshidi, Mostafa Qorbani, Pooneh Ravanasa. Cardiovascular autonomic neuropathy in rheumatoid arthritis assessed by cardiovascular autonomic function tests: A cross-sectional survey. Anatol J Cardiol. 2015; 15(9): 722-726


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