Heart rate turbulence as potential adjuvant index for optimal treatment guidance in severe pulmonary artery hypertension. (14th October 2021)

• Record Type: Journal Article
• Authors: Simeonidou, E; Triantafyllidi, H; Varounis, C; Ntai, K; Katogiannis, K; Apostolopoulou, O; Orphanos, S; Armaganidis, A; Lekakis, J
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Holter Monitoring; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.0312
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Purpose: Despite significant progress achieved in the management of pulmonary arterial hypertension (PAH), the prognosis remains poor. Sudden cardiac death is one main cause of death in advanced disease. It is already known that in pts with PAH there is an alteration in cardiac autonomic nervous activity. Heart rate turbulence (HRT) is an ECG–related autonomic marker, helpful in risk stratification of proarrhythmia and sudden cardiac death. Aim of the study was to examine HRT in patients with severe idiopathic PAH (IPAH) and its relation to disease's progress. Methods: The study population consisted of 46 pts, (32 men and 14 women), mean age 50±9 years, Group A 20 pts: NYHA III, III–IV diagnosed as severe IPAH and Group B 26 pts: NYHA II, II–III diagnosed as moderately severe IPAH. They underwent 24h Holter monitoring-HRT analysis with calculation of 2 parameters, turbulence onset (TO) and turbulence slope (TS) (Abnormal values: TO>0, TS<2.5msec/RR). Pts were defined as HRT(+) when TO and/or TS were abnormal and as HRT(−) when both TO and TS were normal or when HRT could not be calculated because of none or too few suitable PVCs. Reassessment of HRT was undertaken in 6 mo and 1 year in case of change in clinical status. Six pts from group A and 7 pts from group B underwent HRT reassessment because of change in clinical status. Results: Initially abnormal HRT was found in 12 out of 20 pts (n=12, 60%) in group A and in none out of 26 (n=0, 0%) in group B (p=0, 001). In 5 pts out of 8 with clinical improvement and 4 pts with clinical deterioration who had HRT reassessed, significant positive correlation was found between TS and change of clinical status (r=0, 64, p=0, 04). There was a tendency to greater normal TS mean values with clinical improvement even in group where TS was already normal (6, 95±4, 5 vs 3±0, 3 p=0.077). Conclusion: In severe IPAH cardiac autonomic system impairment was demonstrated mainly as abnormal TS in HRT. Significant positive correlation between normalization of TS and clinical improvement was revealed and that raises promises for use of HRT optimization as adjuvant index to guide optimal IPAH therapy and efficacy. Funding Acknowledgement: Type of funding sources: None.