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. 1999 Aug;58(8):481–487. doi: 10.1136/ard.58.8.481

Abnormal autonomic cardiovascular control in ankylosing spondylitis

E Toussirot 1, M Bahjaoui-Bouhaddi 1, J Poncet 1, S Cappelle 1, M Henriet 1, D Wendling 1, J Regnard 1
PMCID: PMC1752931  PMID: 10419866

Abstract

OBJECTIVE—This study was aimed at assessing the contribution of the autonomic nervous system to adjustments of cardiovascular function in patients with ankylosing spondylitis (AS).
METHODS—In 18 AS patients (mean age: 34.9; mean disease duration: 6.4 years) and 13 healthy controls (mean age: 31.7) the changes of heart rate (HR) with deep breathing (E/I ratio) and standing up (30/15 ratio) were recorded. The slope of cardiac baroreflex, the times series of blood pressure and HR values upon lying and standing, and venous plasma concentrations of catecholamines were also analysed. Erythrocyte sedimentation rate (ESR), plasma C reactive protein (CRP) concentration and a clinical index (BASDAI score) were used to assess the degree of disease activity in patients.
RESULTS—In the standing patients, blood pressure was found to decrease progressively (p< 0.001). Furthermore, the patients with a BASDAI score > 5 had a higher heart rate than patients with a BASDAI score < 5 (p<0.02), and there was a trend for a similar difference when patients were classified according to their ESR and CRP. Plasma catecholamine concentrations and the E/I ratio were not different in patients from controls. The 30/15 ratio and the slope of the spontaneous baroreflex during standing were both lower in AS patients than controls (p< 0.01).
CONCLUSIONS—This study demonstrated a change in autonomic nervous system function of AS patients, with a decreased parasympathetic activity, as evidenced by higher HR and lower baroreflex slope. As these significant deviances were mainly observed in patients with more active (or more inflammatory) disease, the autonomic nervous system involvement could be related to the inflammatory process. This autonomic strain may be related to the cardiac involvement in AS patients.



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Figure 1  .

Figure 1  

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Time series average values of systolic (SBP, top traces) and diastolic (DBP, bottom traces) blood pressure in 13 control subjects (thin lines) and 18 patients with ankylosing spondylitis (thick lines) at the end of a supine 30 minute period and during 10 minutes after standing up. Vertical bars indicate group SEM. For clarity of the figure, only one average value has been plotted each 15 seconds, from the beat by beat individual records. BP of control and AS subjects were not different in the supine posture, but during the standing station there was a significant time decrease of systolic and diastolic pressures in the AS patients (p<0.001).

Figure 2  .

Figure 2  

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Time series average values of heart rate in 13 control subjects (control, light triangles and thin lines) and 18 patients with ankylosing spondylitis (AS, thick lines in the A panel) at the end of a supine 30 minute period and during 10 minutes after standing up. Vertical bars indicate group SEM. For clarity of the figure, only one average value has been plotted each 15 seconds, from the beat by beat individual records. In panels B and C thick lines are for average HR values of AS patients with BASDAI score > 5 (n = 10) and ESR > 20 mm 1st h with CRP > 20 mg/l (n = 8), whereas thin lines and light empty circles represent average values for AS patients with BASDAI score lower than 5 (panel B) and patients with ESR < 20 mm 1st h and CRP < 20 mg/l (panel C). Patients with lower criteria of inflammatory disease have clearly HR values values similar to control subjects, and during standing the average values of patients with BASDAI score > 5 were higher than their counterparts with BASDAI < 5 and the controls (panel B, p < 0.02).

Figure 3  .

Figure 3  

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Group average values (and SEM) of the slope of spontaneous baroreflex (SBR) in the supine (left columns of each panel) and standing postures (right columns of each panel). Panel A: white bars = 13 control subjects; hatched bars = 18 AS patients. Panel B: lightly dotted bars = AS patients with BASDAI score < 5; hatched bars = patients with BASDAI score > 5. Panel C: lightly dotted bars = AS patients with ESR < 20 mm 1st h and CRP < 20 mg/l; hatched bars = patients with ESR > 20 mm 1st h and CRP > 20 mg/l. ** = p < 0.01, * = p <0.05 as compared with control subjects in the same standing posture.

Figure 4  .

Figure 4  

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Scatter plots of individual values of RR interval 30/15 ratio (left vertical axis; empty triangles) and standing measured slope of spontaneous cardiac baroreflex (SBR; right vertical axis; black circles) against BASDAI score (panel A) and ESR (panel B) on horizontal axis. Spearman rank correlation coefficients were significant between SBR and BASDAI score (r = −0.56, p < 0.03), and between 30/15 index and ESR (r = −0.55; p < 0.03).

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