Key result
Higher systolic pulmonary arterial pressure in systemic sclerosis patients without pulmonary arterial hypertension was associated with a blunted cardiac autonomic response to orthostatic stress and higher C-reactive protein levels (1.01 vs 0.40 mg/dL, p=0.02).
Why the study?
To test the hypothesis that systemic sclerosis patients with higher systolic pulmonary arterial pressures present blunted cardiac autonomic modulation and a pro-inflammatory profile.
Does higher systolic pulmonary arterial pressure correlate with impaired cardiac autonomic control and pro-inflammatory status in systemic sclerosis patients?
Observational (n=39)
Does higher systolic pulmonary arterial pressure correlate with impaired cardiac autonomic control and pro-inflammatory status in systemic sclerosis patients?
Absolute Event Rate: 1.01% vs 0.4%
p-value: p=0.02
In systemic sclerosis patients without clinical pulmonary hypertension, higher estimated pulmonary pressures correlate with increased inflammation and blunted cardiac autonomic responses, suggesting early cardiopulmonary derangement.
May signal early cardiopulmonary involvement in systemic sclerosis; leaves open causal links to inflammation and autonomic dysfunction.
The current study was undertaken to test the hypothesis that systemic sclerosis (SSc) patients with higher systolic pulmonary arterial pressures (PAPs) present a blunted cardiac autonomic modulation and a pro-inflammatory profile. Thirty-nine SSc patients were enrolled (mean age 57 ± 11 years). ECG and respiration were recorded in the supine (SUP) position and during the active standing (ORT). Heart rate variability (HRV) analysis was performed on samples of 300 beats. The symbolic analysis identified three patterns, 0V%, (sympathetic) and 2UV% and 2LV%, (vagal). The %ΔORT was calculated from the differences between HRV in ORT and SUP, normalized (%) by the HRV values at rest. The PAPs was obtained non-invasively through echocardiography. For the inter-group analysis, participants were allocated in groups with higher (+PAPs ≥ median) and lower PAPs (-PAPs < median) values. At rest, the cardiac sympathetic modulation (represented by 0V%) was positively correlated with PAPs, while parasympathetic modulation (represented by 2LV%) was negatively correlated with PAPs. The dynamic response to ORT (represented by Δ0V% and Δ2LV%), sympathetic and parasympathetic were negatively and positively correlated with PAPs, respectively. The +PAPs group presented a higher inflammatory status and a blunted cardiac autonomic response to ORT (↓Δ0V% and ↑Δ2LV%) compared to the -PAPs group. These findings suggest an interplay among cardiac autonomic control, inflammatory status, and cardiopulmonary mechanics that should be considered for the assessment, monitoring, and treatment of SSc patients.
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Rodrigues et al. (2022) conducted an observational in Systemic Sclerosis (n=39). Higher systolic pulmonary arterial pressure (≥ median) vs. Lower systolic pulmonary arterial pressure (< median) was evaluated on C-reactive protein (CRP) levels (p=0.02). Higher systolic pulmonary arterial pressure in systemic sclerosis patients without pulmonary arterial hypertension was associated with a blunted cardiac autonomic response to orthostatic stress and higher C-reactive protein levels (1.01 vs 0.40 mg/dL, p=0.02).
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