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

Imtinene Ben Mrad; Melek Ben Mrad; Bouthaina Besbes; Ihsen Zairi; Nofeil Ben Kahla; Sofien Kamoun; Khadija Mzoughi; Sondos Kraiem

doi:10.2147/IJGM.S326549

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

Int J Gen Med. 2021 Aug 27:14:4877-4886. doi: 10.2147/IJGM.S326549. eCollection 2021.

Authors

Imtinene Ben Mrad¹, Melek Ben Mrad², Bouthaina Besbes¹, Ihsen Zairi¹, Nofeil Ben Kahla¹, Sofien Kamoun¹, Khadija Mzoughi¹, Sondos Kraiem¹

Affiliations

¹ Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia.
² Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia.

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.

Keywords: Behcet’s disease; autonomic nervous system; disease activity; heart rate variability.