The assessment of autonomic function in patients with systemic amyloidosis: methodological considerations

Abstract

Autonomic neuropathy is a well-known and prognostically important feature of systemic amyloidosis. In other conditions, autonomic function is commonly assessed by cardiovascular reflex tests, described by Ewing, but the feasibility of these tests has not been investigated in patients with systemic amyloidosis. We studied autonomic function in amyloidotic patients using cardiovascular tests and assessed their feasibility

Patients with AA, AL and ATTR amyloidosis participated In all patients, cardiovascular refex testing (mental arithmetic stress test and head-up tilting, besides the Ewingtests) was performed

Of the 46 patients included, only 28 patients could perform all 4 Ewing-tests. In particular, patients with AA amyloidosis secondmy to rheumatoid arthritis could not perform standing up and the isometric handgrip test. However, when the mental stress test replaced the handgrip test and head-up tilting replaced standing up, in 45 of the 46 patients, autonomic function could be assessed with cardiovascular refex tests. Hay of the patients with AA amyloidosis had signs of autonomic neuropathy—which was more than expected

We propose to replace the isometric handgrip test with the mental arithmetic stress test and standing up with head-up tilting if a patient is not able to perform these tests.

Key Words:

• autonomic neuropathy
• systemic amyloidosis