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Autonomic neural control of the cardiovascular system in patients with Behçet’s disease in the absence of neurological involvement

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Abstract

Behçet’s disease (BD) is a chronic multi-system disease presenting with recurrent oral and genital ulceration, and relapsing uveitis. Heart rate recovery (HRR) after exercise is a marker of parasympathetic activity. A delayed recovery of systolic blood pressure (SBP) after exercise might reflect sympathetic hyperactivity. The analysis of variations in heart rate has also been used to determine the balance between sympathetic and vagal nerve activities in the heart. Our objective was to determine HRR, the SBP response to exercise and heart rate variability (HRV) in patients with BD in the absence of neurological involvement. The study population consisted of 32 patients with BD and 30 healthy controls who were matched with respect to age, sex, and physical activity. Heart rate recovery was calculated as the difference between heart rate at peak exercise and heart rate at 1, 2, and 3 min of recovery. Blood pressure recovery indexes were determined by dividing the systolic blood pressure at 2 and 3 min in recovery to the systolic blood pressure at peak exercise. In patients with BD, mean HRR at 1 min (HRR1) were not significantly different than that of controls (21 ± 7 vs 20 ± 7 bpm, p = 0.50). Although, resting mean SBP of patients with BD was higher than controls (121 ± 13 vs 115 ± 12 mmHg, p = 0.039), the SBP recovery indices of the patients with BD at 2 and 3 min were similar to those of controls (0.84 ± 0.07 vs 0.84 ± 0.09, p = 0.89 and 0.78 ± 0.09 vs 0.78 ± 0.08, p = 0.93, respectively). Both time domain and frequency domain parameters of patients with BD were similar to that of controls. This study shows that the patients with BD have normal HRR1 and normal SBP response to exercise and normal HRV. These findings might suggest unaltered autonomic neural control of the cardiovascular system in this disorder in the absence of neurological involvement.

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References

  1. International Study Group for Behcet’s disease (1990) Criteria for diagnosis of Behcet’s disease. Lancet 335:1078–1080

    Google Scholar 

  2. Lakhanpal S, Tani K, Lie JT, Katoh K, Ishigatsuto Y, Ohokula T (1985) Pathologic features of Behcet’s syndrome: a review of Japanese autopsy registry data. Hum Pathol 16:790–795

    Article  PubMed  CAS  Google Scholar 

  3. Marzban M, Mandegar MH, Karimi A, Abbasi K, Movahedi N, Navabi MA, Abbasi SH, Moshtaghi N (2008) Cardiac and great vessel involvement in "Behcet’s disease". J Card Surg 23:765–768

    Article  PubMed  Google Scholar 

  4. Lown B, Verrier RL (1976) Neural activity and ventricular fibrillation. N Engl J Med 294:1165–1170

    Article  PubMed  CAS  Google Scholar 

  5. Aksoyek S, Aytemir K, Ozer N, Ozcebe O, Oto A (1999) Assessment of autonomic nervous system function with Behcet’s disease by spectral analysis of heart rate variability. J Auton Nerv Syst 77:190–194

    Article  CAS  Google Scholar 

  6. Bayramlar H, Hepsen IF, Uguralp M, Boluk A, Ozcan C (1998) Autonomic nervous system involvement in Behcet’s disease: a pupillometric study. J Neuroophthalmol 18:182–186

    Article  PubMed  CAS  Google Scholar 

  7. Karatas GK, Onder M, Meray J (2002) Autonomic nervous system involvement in Behcet’s disease. Rheumatol Int 22:155–159

    Article  PubMed  Google Scholar 

  8. Ozdemir R, Sezgin AT, Topal E, Kutlu R, Barutcu I, Gullu H (2003) Findings of ambulatory blood pressure monitoring and heart rate variability in patients with Behcet’s disease. Am J Cardiol 92:646–648

    Article  PubMed  Google Scholar 

  9. Kaya EB, Yorgun H, Akdogan A, Ates AH, Canpolat U, Sunman H, Aytemir K, Tokgozoglu L, Kabakci G, Calguneri M, Ozkutlu H, Oto A (2009) Heart-rate recovery index is impaired in Behçet’s disease. Tex Heart Inst J 6:282–286

    Google Scholar 

  10. Arai Y, Saul JP, Albrecht P, Hartley LH, Lilly LS, Cohen RJ, Colucci WS (1989) Modulation of cardiac autonomic activity during and immediately after exercise. Am J Physiol Jan 256:132–141

    Google Scholar 

  11. Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H, Takeda H, Inoue M, Kamada T (1994) Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol 24:1529–1535

    Article  PubMed  CAS  Google Scholar 

  12. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS (1999) Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med 341:1351–1357

    Article  PubMed  CAS  Google Scholar 

  13. Cole CR, Foody JM, Blackstone EH, Lauer MS (2000) Heart rate recovery after submaximal exercise testing as a predictor of mortality in a cardiovascularly healthy cohort. Ann Intern Med 132:552–555

    PubMed  CAS  Google Scholar 

  14. Tsuda M, Hatano K, Hayashi H, Yokota M, Hirai M, Saito H (1993) Diagnostic value of postexercise systolic blood pressure response for detecting coronary artery disease in patients with or without hypertension. Am Heart J 125:718–725

    Article  PubMed  CAS  Google Scholar 

  15. Kitaoka H, Takata J, Furuno T, Yamasaki F, Chikamori T, Doi YL (1997) Delayed recovery of postexercise blood pressure in patients with chronic heart failure. Am J Cardiol 79:1701–1704

    Article  PubMed  CAS  Google Scholar 

  16. Miyahara T, Yokota M, Iwase M, Watanabe M, Matsunami T, Koide M, Saito H, Takeuchi J (1990) Mechanism of abnormal postexercise systolic blood pressure response and its diagnostic value in patients with coronary artery disease. Am Heart J 120:40–49

    Article  PubMed  CAS  Google Scholar 

  17. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use (1996) Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 17:354–381

    Google Scholar 

  18. American College of Sports Medicine (1995) ACSM’s Guidelines for exercise testing and prescription. Williams & Wilkins, pp 153–240

  19. Watanabe J, Thamilarasan M, Blackstone E, Thomas JD, Lauer MS (2001) Heart rate recovery immediately after treadmill exercise and left ventricular systolic dysfunction as predictors of mortality: the case of stress echocardiography. Circulation 104:1911–1916

    PubMed  CAS  Google Scholar 

  20. Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS (2000) Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA 284:1392–1398

    Article  PubMed  CAS  Google Scholar 

  21. Ellis K, Pothier CE, Blackstone EH, Lauer MS (2004) Is systolic blood pressure recovery after exercise a predictor of mortality? Am Heart J 147:287–292

    Article  PubMed  Google Scholar 

  22. van Boven AJ, Jukema JW, Haaksma J, Zwinderman AH, Crijns HJ, Lie KI (1998) Depressed heart rate variability is associated with events in patients with stable coronary artery disease and preserved left ventricular function. REGRESS Study Group. Am Heart J 135:571–576

    Article  PubMed  Google Scholar 

  23. Forslund L, Bjorkander I, Ericson M, Held C, Kahan T, Rehnqvist N, Hjemdahl P (2002) Prognostic implications of autonomic function assessed by analyses of catecholamines and heart rate variability in stable angina pectoris. Heart 87:415–422

    Article  PubMed  CAS  Google Scholar 

  24. Nolan J, Batin PD, Andrews R, Lindsay SJ, Brooksby P, Mullen M, Baig W, Flapan AD, Cowley A, Prescott RJ, Neilson JM, Fox KA (1998) Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). Circulation 98:1510–1516

    Article  PubMed  CAS  Google Scholar 

  25. Bigger JT Jr, Fleiss JL, Rolnitzky LM, Steinman RC (1993) Frequency domain measures of heart period variability to assess risk late after myocardial infarction. J Am Coll Cardiol 21:729–736

    Article  PubMed  Google Scholar 

  26. Tsuji H, Larson MG, Venditti FJ Jr, Manders ES, Evans JC, Feldman CL, Levy D (1996) Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation 94:2850–2855

    Article  PubMed  CAS  Google Scholar 

  27. Sandercock GR, Bromley PD, Brodie DA (2005) The reliability of short-term measurements of heart rate variability. Int J Cardiol 103:238–247

    Article  PubMed  Google Scholar 

  28. Kleiger RE, Stein PK, Bosner MS, Rottman JN (1992) Time domain measurements of heart rate variability. Cardiol Clin 10:487–498

    PubMed  CAS  Google Scholar 

  29. Ewing DJ, Neilson JM, Travis P (1984) New method for assessing cardiac parasympathetic activity using 24 hour electrocardiograms. Br Heart J 52:396–402

    Article  PubMed  CAS  Google Scholar 

  30. Stein PK (2002) Assessing heart rate variability from real-world Holter reports. Card Electrophysiol Rev 6:239–244

    Article  PubMed  Google Scholar 

  31. Serdaroglu P (1998) Behçet’s disease and the nervous system. J Neurol 245:197–205

    Article  PubMed  CAS  Google Scholar 

  32. Akman-Demir G, Serdaroglu P, Tasçi B (1999) Clinical patterns of neurological involvement in Behçet’s disease: evaluation of 200 patients. The Neuro-Behçet Study Group. Brain 122:2171–2182

    Article  PubMed  Google Scholar 

  33. Serdaroğlu P, Yazici H, Ozdemir C, Yurdakul S, Bahar S, Aktin E (1989) Neurologic involvement in Behçet’s syndrome. A prospective study. Arch Neurol 46:265–269

    Article  PubMed  Google Scholar 

  34. Akman-Demir G, Baykan-Kurt B, Serdaroglu P, Gürvit H, Yurdakul S, Yazici H, Bahar S, Aktin E (1996) Seven-year follow-up of neurologic involvement in Behçet syndrome. Arch Neurol 53:691–694

    Article  PubMed  CAS  Google Scholar 

  35. Seyahi E, Yurdakul S (2011) Behçet’s syndrome and thrombosis. Mediterr J Hematol Infect Dis 3:e2011026

    Article  PubMed  Google Scholar 

  36. Kaaja RJ, Poyhonen-Alho MK (2006) Insulin resistance and sympathetic overactivity in women. J Hypertens 24:131–141

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Tansel Erol.

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Erol, T., Tekin, A., Tufan, M. et al. Autonomic neural control of the cardiovascular system in patients with Behçet’s disease in the absence of neurological involvement. Clin Rheumatol 31, 1499–1504 (2012). https://doi.org/10.1007/s10067-012-2045-x

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  • DOI: https://doi.org/10.1007/s10067-012-2045-x

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