Author's Reply

To the Editor,

We appreciate the careful review and insightful comments by our colleagues regarding our recent study entitled “Cardiovascular autonomic neuropathy in rheumatoid arthritis assessed by cardiovascular autonomic function tests: A cross-sectional survey,” which was published in Anatol J Cardiol on Nov 11, 2014. (1)

In our study, we assessed cardiovascular autonomic neuropathy (CAN) in rheumatoid arthritis (RA) patients compared with that in control subjects by bedside autonomic function tests (1).

These tests include the following: 1) beat-to-beat heart rate variation during deep breathing, 2) heart rate response to standing up, 3) heart rate response to the Valsalva maneuver, 4) blood pressure response to standing up, and 5) blood pressure response to a sustained handgrip.

There are other approaches for evaluating the autonomic nervous system by heart rate variability (HRV) parameters from short- or long-term monitoring (2). We agree that HRV and bedside autonomic function tests for evaluating the autonomic nervous system provide complementary information regarding autonomic regulatory mechanisms in health and disease. However, the bedside autonomic function tests were more feasible for us during the study.

We also considered that spectrum bias may account for differences in the reported results between the investigations.

Therefore, in order to point out the difference between the cardiovascular autonomic function of RA patients and general population, we will design another prospective cohort study with complementary and more sensitive tests.