Sympatho-Vagal Dysfunction in Patients with End-Stage Lung Disease Awaiting Lung Transplantation.

Eleonora Tobaldini,Mario Nosotti,Gabriel D D Rodrigues,Alice Monti,Camilla Cirelli,Stefano Aliberti,Valeria Rossetti,Letizia Corinna Morlacchi,Ilaria Righi,Nicola Montano,Giulia Coti Zelati,Pedro Paulo Da S Soares,Paolo Tarsia,Giorgio Mantoan,Francesco Blasi

doi:10.3390/jcm9041146

Abstract

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.

Highlights

Lung transplantation (LTx) is a reliable lifesaving option for selected individuals with end-stage pulmonary disease
The results of the current study indicate that in patients with end-stage lung disease there is a prominent reduction in cardiac autonomic modulation in the direction of vagal control and an increase in sympathetic modulation in comparison to age- and sex- matched healthy individuals
The current study demonstrated that patients with more severe end-stage lung disease had an autonomic profile characterized by a predominant respiratory vagal modulation and a loss of sympathetic rhythmic oscillation

Summary

Introduction

Lung transplantation (LTx) is a reliable lifesaving option for selected individuals with end-stage pulmonary disease. The number of LTx is increasing over time, the mortality during the waiting period is still high [1]. One of the possible complications in patients on the waiting list for LTx are cardiovascular events, which could impact the mortality rate. The factors that impact the outcome of patients referred for LTx still need to be elucidated [2]. Cardiac autonomic modulation seems impaired in pulmonary diseases [5,6,7], the interplay between cardiac autonomic modulation and severity of end-stage pulmonary disorders in patients waiting for LTx has not been studied yet

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