EVALUATION OF CARDIAC AUTONOMIC FUNCTION WITH HOLTER ECG MONITORING IN PATIENTS WITH SYSTEMIC SCLEROSIS
Authors:   Cardiology Department, Rehabilitation Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Muresan Lucian , Petcu Ana ,   Rheumatology Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Muresan Crina ,   Department of Internal Medicine, Second Medical Clinic,  Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Pamfil Cristina ,   Rheumatology Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Rinzis Mirela ,   Rheumatology Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Irsay Laszlo ,   Physical and Rehabilitation Medicine Department, Rehabilitation Hospital,  Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Bordnic Ecaterina ,   Physical and Rehabilitation Medicine Department, Rehabilitation Hospital,  Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Pop Dana ,   Cardiology Department, Rehabilitation Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Zdrenghea Dumitru ,   Cardiology Department, Rehabilitation Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Rednic Simona ,   Cardiology Department, Rehabilitation Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Published: September 2021

Purpose. Cardiac autonomic dysfunction is frequently encountered among patients with systemic sclerosis. Its presence correlates with potentially fatal ventricular arrhythmias, having a good positive predictive value for mortality. The aim of this paper was to identify cardiac autonomic dysfunction in patients with systemic sclerosis using Holter ECG monitoring and to assess the possible correlations between its presence and other disease characteristics. Material and methods. Forty nine patients with diffuse cutaneous and limited cutaneous scleroderma, diagnosed according to the American College of Rheumatology/EULAR 2013 criteria underwent ECG, transthoracic echocardiography, blood sample testing, chest X-ray and spirometry. Subsequently, all patients and a control group of 49 healthy subjects underwent Holter ECG monitoring with time and frequency domain heart rate variability (HRV) analysis. Results. Scleroderma patients had significantly lower HRV values compared to controls: SDNN (123 ± 39.4 vs. 143.2 ± 32, p =0.001), SDANN (137.2 ± 34.9 vs. 127.9 ± 25.7, p=0.001), TI (-) (30.6 ± 9.6 vs. 38.1 ± 8.9, p=0.01) and TINN (758.8 ± 208 vs. 815.1 ± 138, p=0.04). The LF/HF ratio was significantly higher among patients with diffuse scleroderma (1.18 ± 0.34 vs. 1.08 ± 0.43, p= 0.005). There was a positive correlation between the TI values, SDANN and the duration from the onset of Raynaud’s phenomenon (r=0.399, p=0.016) (r=0.419, p=0.011), between the SDANN values and systolic pulmonary arterial pressure (sPAP) values (0.032, p=0.034) and a negative correlation between the LF/HF values and the patients’ age (r=-0.442, p=0.001), the duration from the onset of non-Raynaud’s phenomenon (r=-0.395, p=0.034), echocardiographic value of sPAP(r=-0.330, p=0.035) and the total number of premature ventricular contractions (r=-0.0459, p=0.001). Conclusion. Patients with systemic sclerosis often have cardiac autonomic dysfunction, which can be diagnosed with Holter ECG monitoring.