Poliwczak Adam R, Waszczykowska Elżbieta, Dziankowska-Bartkowiak Bożena, Dworniak-Pryca Katarzyna
Department of Human Physiology, Medical University of Lodz, Lodz, Poland.
Department of Dermatology and Venereology, Medical University of Lodz, Lodz, Poland.
Postepy Dermatol Alergol. 2019 Dec;36(6):707-713. doi: 10.5114/ada.2019.83134. Epub 2019 Feb 26.
Systemic sclerosis (SSc) is a connective tissue disease manifested by progressive fibrosis of many internal organs including the cardiovascular system and development of autonomic disorders with sympathetic predominance. These abnormalities can increase cardiovascular mortality.
To evaluate heart rate turbulence (HRT) and variability (HRV) parameters (indicator of autonomic imbalance) obtained from 24-hour ECG Holter monitoring, as predictors of the increased cardiovascular risk in patients with scleroderma.
Thirty-twoscleroderma patients and 30 healthy people were included. After clinical examination, ECG, routine laboratory tests and echocardiography, participants performed 24-hour Holter-ECG at home. For HRT assessment, turbulence onset () and turbulence slope () parameters were used. Both time and frequency domain analysis of HRV was used. The HRV circadian rhythm was also evaluated.
Time domain: SDNN, SDNN-ix, SDANN and frequency domain: LF, VLF, ULF, NHF, NLF, parameters were lower, while p50NN was higher in SSc as compared to the control group. There was also a loss of the circadian rhythm for r-MSSD and p50NN present in the control group. Abnormal HRT parameters To and/or Ts occurred in the SSc group only. The median value of = -1.24% and = 11.13 ms/RR did not differ significantly as compared to the control group.
The study confirmed the presence of HRV disturbances, including HRV circadian rhythm, as it may seem at an early stage of SSc. The HRT disorders may be characterized by the increasing changes with advancing disease. This indicates the presence of autonomic imbalance and an increased cardiovascular risk.
系统性硬化症（SSc）是一种结缔组织疾病，表现为包括心血管系统在内的许多内脏器官进行性纤维化，并出现以交感神经占优势的自主神经功能紊乱。这些异常会增加心血管疾病死亡率。
评估通过24小时动态心电图监测获得的心率震荡（HRT）和变异性（HRV）参数（自主神经失衡指标），作为硬皮病患者心血管风险增加的预测指标。
纳入32例硬皮病患者和30名健康人。经过临床检查、心电图、常规实验室检查和超声心动图检查后，参与者在家中进行24小时动态心电图监测。用于HRT评估的参数为震荡起始（）和震荡斜率（）。同时采用了HRV的时域和频域分析方法。还评估了HRV的昼夜节律。
时域方面：与对照组相比，SSc患者的SDNN、SDNN-ix、SDANN以及频域方面的LF、VLF、ULF、NHF、NLF参数较低，而p50NN较高。对照组中存在的r-MSSD和p50NN的昼夜节律在SSc患者中也消失了。仅在SSc组出现了异常的HRT参数To和/或Ts。与对照组相比，= -1.24%和 = 11.13 ms/RR的中位数无显著差异。
该研究证实了HRV紊乱的存在，包括HRV昼夜节律，这在SSc疾病早期可能就已出现。HRT紊乱可能随着疾病进展而变化加剧。这表明存在自主神经失衡以及心血管风险增加。
