Key result
End-stage lung disease patients showed higher sympathetic and lower vagal modulation than healthy controls, though the most severe patients exhibited a loss of sympathetic modulation.
Why the study?
Although cardiac autonomic control can be impaired in chronic pulmonary diseases, its interplay with disease severity in end-stage lung disease had not yet been studied.
Does end-stage lung disease and its severity alter cardiac autonomic control in patients awaiting lung transplantation?
Case-Control (n=98)
No
Does end-stage lung disease and its severity alter cardiac autonomic control in patients awaiting lung transplantation?
End-stage lung disease alters cardiac autonomic control, with severe disease paradoxically leading to a loss of sympathetic rhythmic oscillation and predominant vagal modulation.
Autonomic imbalance in end-stage lung disease may aid risk stratification in LTx candidates; leaves open whether HRV improves prognostic models.
Although the literature demonstrates that cardiac autonomic control (CAC) might be impaired in patients with chronic pulmonary diseases, the interplay between CAC and disease severity in end-stage lung disease has not been studied yet. We investigated the effects of end-stage lung disease on CAC through the analysis of heart rate variability (HRV) among patients awaiting lung transplantation. Forty-nine patients on the waiting list for lung transplantation (LTx; 19 men, age 38 ± 15 years) and 49 healthy non-smoking controls (HC; 22 men, age 40 ± 16 years) were enrolled in a case-control study at Policlinico Hospital in Milan, Italy. LTx patients were divided into two groups, according to disease severity evaluated by the Lung Allocation Score (LAS). To assess CAC, electrocardiogram (ECG) and respiration were recorded at rest for 10 min in supine position and for 10 min during active standing. Spectral analysis identified low and high frequencies (LF, sympathetic, and HF, vagal). Symbolic analysis identified three patterns, i.e., 0V% (sympathetic) and 2UV% and 2LV% (vagal). Compared to HCs, LTx patients showed higher markers of sympathetic modulation and lower markers of vagal modulation. However, more severely affected LTx patients, compared to less severely affected ones, showed an autonomic profile characterized by loss of sympathetic modulation and predominant vagal modulation. This pattern can be due to a loss of sympathetic rhythmic oscillation and a subsequent prevalent respiratory modulation of heart rate in severely affected patients.
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Tobaldini et al. (2020) conducted a case-control in End-stage lung disease (n=98). End-stage lung disease vs. Healthy non-smoking controls was evaluated on Cardiac autonomic control assessed by heart rate variability (HRV). End-stage lung disease patients showed higher sympathetic and lower vagal modulation than healthy controls, though the most severe patients exhibited a loss of sympathetic modulation.
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