Masini Francesco, Galiero Raffaele, Pafundi Pia Clara, Gjeloshi Klodian, Pinotti Emanuele, Ferrara Roberta, Romano Ciro, Adinolfi Luigi Elio, Sasso Ferdinando Carlo, Cuomo Giovanna
Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
Department of Precision Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy.
J Scleroderma Relat Disord. 2021 Oct;6(3):256-263. doi: 10.1177/23971983211020617. Epub 2021 Jun 7.
Cardiac autonomic neuropathy is among the known cardiovascular complications of systemic sclerosis and may affect the whole prognosis of the disease. The aim of our study was to assess cardiac autonomic neuropathy prevalence in our cohort of systemic sclerosis patients and compare its main features with clinical and epidemiological data, particularly with the severity of microvascular damage, as detected by nailfold videocapillaroscopy.
Twenty-six patients with definite systemic sclerosis were consecutively enrolled at our outpatient rheumatology clinic. All patients underwent physical examination, nailfold videocapillaroscopy, and autonomic neuropathy diagnostic tests (orthostatic hypotension test, deep breathing test, lying-to-standing, and Valsalva maneuvers).
Cardiac autonomic neuropathy prevalence was 50% (13 cases). On univariate analysis, cardiac autonomic neuropathy was shown to be significantly associated with an active pattern on nailfold videocapillaroscopy (odds ratio 5.86, 95% confidence interval 1.59-9.24; = 0.032), whereas anti-Scl-70 positivity (odds ratio, 0.24; 95% confidence interval, 0.03-2.12; = 0.049) and C-reactive protein (odds ratio, 19.32; 95% confidence interval, 1.79-56.71; = 0.036) reached only a borderline statistical association. The time-dependent Cox multivariate regression model showed cardiac autonomic neuropathy development to be independently associated with an active pattern on nailfold videocapillaroscopy (odds ratio, 7.19; 95% confidence interval, 1.87-8.96; = 0.042) and anti-Scl-70 positivity (odds ratio, 5.92; 95% confidence interval, 1.06-18.43; = 0.048).
Severe microvascular damage, as detected by nailfold videocapillaroscopy, may suggest the coexistence of autonomic dysfunction and should be considered as a red flag for the identification of patients particularly at risk of cardiac morbidity and mortality.
心脏自主神经病变是系统性硬化症已知的心血管并发症之一，可能影响疾病的整体预后。我们研究的目的是评估我们队列中系统性硬化症患者心脏自主神经病变的患病率，并将其主要特征与临床和流行病学数据进行比较，特别是与通过甲襞视频毛细血管镜检测到的微血管损伤严重程度进行比较。
在我们的门诊风湿病诊所连续招募了26例确诊为系统性硬化症的患者。所有患者均接受了体格检查、甲襞视频毛细血管镜检查以及自主神经病变诊断测试（直立性低血压试验、深呼吸试验、卧立位试验和瓦尔萨尔瓦动作）。
心脏自主神经病变患病率为50%（13例）。单因素分析显示，心脏自主神经病变与甲襞视频毛细血管镜检查的活跃模式显著相关（比值比5.86，95%置信区间1.59 - 9.24；P = 0.032），而抗Scl - 70阳性（比值比，0.24；95%置信区间，0.03 - 2.12；P = 0.049）和C反应蛋白（比值比，19.32；95%置信区间，1.79 - 56.71；P = 0.036）仅达到临界统计学关联。时间依赖性Cox多变量回归模型显示，心脏自主神经病变的发生与甲襞视频毛细血管镜检查的活跃模式（比值比，7.19；95%置信区间，1.87 - 8.96；P = 0.042）和抗Scl - 70阳性（比值比，5.92；95%置信区间，1.06 - 18.43；P = 0.048）独立相关。
通过甲襞视频毛细血管镜检测到的严重微血管损伤可能提示自主神经功能障碍的共存，应被视为识别特别有心脏发病和死亡风险患者的警示信号。
