Abstract

This study evaluates whether the cardiac autonomic response to head-up tilt test (HUTT) differs between patients with relapsing-remitting multiple sclerosis (RRMS) and those with progressive MS (PMS) as compared to healthy controls (HC). Baroreflex sensitivity, cardiac parameters, heart rate (HRV) and blood pressure variability (BPV) were compared between 28 RRMS, 21PMS and 25 HC during HUTT. At rest, PMS patients had higher values of the sympathovagal ratio, a low-frequency band HRV (LFnu-RRI) and lower values of parasympathetic parameters (HFnu-RRI, HF-RRI) compared to RRMS and HC. Resting values of cardiac parameters were significantly lower in RRMS compared to PMS patients. No intergroup differences were observed for post-tilt cardiac and autonomic parameters, except for delta HF-RRI with lower values in the PMS group. The MS variant corrected for age, sex and Expanded Disability Status Scale (EDSS) score was an independent predictor of changes in the sympathovagal ratio as measured by HRV. Furthermore, a higher overall EDDS score was related to a higher sympathovagal ratio, lower parasympathetic parameters at rest, and decrease post-tilt changes of the sympathovagal ratio of sBP BPV. Autonomic imbalance is markedly altered in the MS patient group compared to control changes were most pronounced in the progressive variant of MS disease. The MS variant appeared to have a potential influence on cardiac autonomic imbalance at rest.

Highlights

  • Multiple sclerosis (MS) is a chronic disorder characterized by autoimmune inflammation coupled to demyelination and followed later by central nervous system (CNS) neurodegeneration [1]

  • A higher overall EDDS score was related to a higher sympathovagal ratio (LF/HF-sBP, LF-HF-diastolic blood pressure (dBP)), and lower parasympathetic parameters (HFnu-dBP, HFnu-sBP) at rest, and decreased post-tilt changes of LF/HF-sBP

  • We conclude that autonomic imbalance is markedly altered in the MS patient group compared to controls, changes were most pronounced in the progressive variant of MS disease

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Summary

Introduction

Multiple sclerosis (MS) is a chronic disorder characterized by autoimmune inflammation coupled to demyelination and followed later by central nervous system (CNS) neurodegeneration [1]. Some studies indicate that up to 50% of relapsing-remitting MS (RRMS) patients will experience conversion to secondary progressive MS (SPMS) on average between 19 and 25 years after onset of the disease [2,3]. Reports related to the disease course in patients with MS are increasing, the nature of autonomic dysfunction (AD) seen frequently in MS remains unclear. Others suggest that sympathetic dysfunction is closely related to progression in clinical disability and autonomic imbalance in the progressive phenotype of MS [10]. Some reports have indicated that cardiac AD is altered more in patients with progressive MS than in relapsing-remitting RR [9,10,14]. Spectral analysis of beat-to-beat BPV and HRV are increasingly recognized as sensitive tools of cardiovascular autonomic regulation in patients with neurological diseases [16]

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