Impairment of Autonomic Nervous System Activity in Patients With Pulmonary Arterial Hypertension: A Case Control Study

Abstract

Background Chronotropic response to exercise (CR) and heart rate recovery (HRR) immediately after exercise are indirect indices of sympathetic and parasympathetic activity, respectively. The aim of this study was to evaluate CR and HRR in patients with pulmonary arterial hypertension (PAH) in relation to disease severity. Methods and Results Ten PAH patients (6 females/4 males, mean age: 48 ± 12 years) and 10 control subjects matched for age, gender, and body mass index (6 females/4 males, mean age: 46 ± 6 years) performed a ramp incremental symptom-limited cardiopulmonary exercise test on a cycle ergometer. Main measurements included heart rate at rest (HR), CR = [(peak HR-resting HR/220-age-resting HR) × 100, %], HRR 1 = HR difference from peak exercise to 1 minute after, ventilatory efficiency during exercise (VE/VCO 2 slope), peak oxygen uptake (VO 2p), and the first-degree slope of VO 2 for the first minute of the recovery period (VO 2/t-slope). PAH patients had a significantly decreased CR (58 ± 31 vs 92 ± 13, %, P < .001) and HRR 1 (10 ± 5 vs 29 ± 6, beats/min, P < .001) as well as VO 2p (11.9 ± 3.5 vs 26.9 ± 6.6, mL·kg·min) and VO 2/t-slope (0.2 ± 0.1 vs. 0.9 ± 0.2, mL·kg·min 2) compared with controls. CR and HRR 1 correlated well with VO 2p ( r = 0.7; P < .001 and r = 0.85; P < .001, respectively) and VO 2/t-slope (r = 0.66; P < .001 and r = 0.85; P < .001, respectively) and had a significant inverse correlation with VE/VCO 2 slope ( r = –0.47; P < .01 and r = –0.77; P < .001, respectively). Conclusions PAH patients present a significant impairment of CR and HRR 1 in relation to disease severity, indicating profound autonomic nervous system abnormalities.