Heart Rate Variability as an Indicator of Autonomic Nervous System Disturbance in Behcet’s Disease

Abstract

Background

Behçet’s disease (BD) is a multisystemic vasculiti where cardiac involvement is not common. Previous studies have shown that the incidence of ventricular arrhythmia and sudden cardiac death (SCD) is higher in patients with BD than in the healthy population. Among various possible explanations, autonomic nervous system (ANS) dysfunction has been suggested. Few studies have evaluated ANS function in patients with BD, and the results obtained are controversial.

Objective

We aimed to assess cardiac autonomic function by heart rate variability (HRV) in patients with BD; to evaluate circadian changes in HRV; and to study the relationship between HRV parameters and disease parameters.

Methods

Thirty-six patients with Behçet’s disease (median age 42 years, 28 men) and 36 age- and sex-matched healthy volunteers were included. HRV analyses were performed in the time and frequency domains for the entire 24-hour period and for the daytime and nighttime periods. BD activity was studied with Behcet’s disease current activity form (BDCAF).

Results

Patients with BD had significantly lower values of SDNN compared to controls. PNN50, RMSSD, and HF components mean values were significantly reduced in patients than in controls implying parasympathetic impairment. LF was comparable between the two groups, whereas LF/HF ratio was significantly higher in BD group. The circadian rhythm of HRV was preserved in patient group. There was no significant correlation of CRP or disease duration with HRV indices in Behçet’s subjects. BDCAF score was found to be negatively correlated with LF/HF.

Conclusion

Patients with BD, despite no cardiovascular involvement, have reduced parasympathetic activity compared with controls. However, circadian rhythms of autonomic function were preserved. As known, there is strong evidence for the role of the ANS in the pathogenesis of ventricular arrhythmias. Thus, being a practical tool, HRV can be an interesting approach for the rhythmic follow-up of BD patients.

Graphical abstract

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Keywords:

• Behcet’s disease
• autonomic nervous system
• heart rate variability
• disease activity

Highlights Section

• Patients with Behcet disease, despite no cardiovascular involvement, have reduced parasympathetic activity compared with controls. Then they have an increased risk of ventricular arrhythmia.

• Circadian rhythm of heart rate variability is preserved in Behcet disease patients.

• Heart rate variability, as practical tool, can be an interesting approach for the rhythmic follow-up of Behcet disease patients.

Disclosure

The authors report no conflicts of interest for this work.