Why the study?
The cardiac autonomic profile had not yet been evaluated during angioedema attack or prodromal phases in C1-inhibitor hereditary angioedema.
Does heart rate variability change during the prodromal and attack phases in patients with C1-inhibitor hereditary angioedema?
Does heart rate variability change during the prodromal and attack phases in patients with C1-inhibitor hereditary angioedema?
Heart rate variability analysis reveals increased vagal modulation during the prodromal phase of angioedema attacks, suggesting its potential as an early marker for impending attacks.
Suggests HRV changes as possible prodromal marker in hereditary angioedema; hypothesis-generating and needs confirmation in prospective studies.
C1-inhibitor hereditary angioedema (C1-INH-HAE) is a rare disease characterized by self-limiting edema associated with localized vasodilation due to increased levels of circulating bradykinin. C1-INH-HAE directly influences patients' everyday lives, as attacks are unpredictable in frequency, severity, and the involved anatomical site. The autonomic nervous system could be involved in remission. The cardiac autonomic profile has not yet been evaluated during the attack or prodromal phases. In this study, a multiday continuous electrocardiogram was obtained in four C1-INH-HAE patients until attack occurrence. Power spectral heart rate variability (HRV) indices were computed over the 4 h preceding the attack and during the first 4 h of the attack in three patients. Increased vagal modulation of the sinus node was detected in the prodromal phase. This finding may reflect localized vasodilation mediated by the release of bradykinin. HRV analysis may furnish early markers of an impending angioedema attack, thereby helping to identify patients at higher risk of attack recurrence. In this perspective, it could assist in the timing, titration, and optimization of prophylactic therapy, and thus improve patients' quality of life.
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Perego et al. (2021) studied this question.
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