Abnormal heart rate recovery on exercise in ankylosing spondylitis

Exercise capacity in axial spondyloarthritis and associated factors: A cross-sectional controlled study

OBJECTIVE

To examine the associations between exercise capacity (EC), cardiovascular (CV) risk factors and disease-related variables in axial spondyloarthritis (AxSpA) patients.

METHODS

In this cross-sectional controlled study, CV risk profile data, physical activity, 10-year CV event risk estimated by the Framingham model and Ankylosing Spondylitis Disease Activity Score - C-reactive protein were recorded. A maximal treadmill exercise test by Bruce protocol was administered. Analyses of covariance were performed with adjustments for age, smoking status and physical activity level. Linear regression analysis was performed to study the association between EC and related CV risk factors.

RESULTS

Thirty-eight patients and 38 age-gender matched controls were recruited between May and October 2014. Patients had significantly lower EC than controls (MD 2.2; metabolic equivalents 0.91-3.49; P = .001). The difference remained significant after adjustments (P = .001). There were significant correlations between EC and age, 10-year CV event risk, body mass index (BMI) and waist circumference for patients and controls (P < .001 and P < .05, respectively). There was a significant relationship between EC and total cholesterol, triglycerides and heart rate recovery (HRR) in patients (P = .04, P < .001 and P = .006, respectively). High-density lipoprotein - cholesterol was significantly higher, and BMI was significantly lower in nonradiographic AxSpA patients (P = .026 and P = .03 respectively). Age and triglyceride levels were found as the significant predictors for EC in the AxSpa group (for age β = -.105, P = .003; for triglycerides β = -.016 P = .003).

CONCLUSION

Exercise capacity was significantly lower and attenuated HRR was significantly associated with low EC and high 10-year CV event risk in AxSpA patients.

The relevance of performing exercise test before starting supervised physical exercise in asymptomatic cardiovascular patients with rheumatic diseases

OBJECTIVES

To evaluate the impact and risk factors associated with an abnormal exercise test (ET) in systemic inflammatory rheumatic disease (SIRD) patients before commencing supervised physical exercise.

METHODS

A total of 235 SIRD patients were enrolled in three controlled clinical trials, including 103 RA, 42 SLE and 57 AS patients. The control group consisted of 231 healthy, sedentary subjects matched for age, gender and BMI. All performed an ET, according to Bruce's or Ellestad's protocol. Cardiovascular disease risk factors, medications, comorbidities and details of each SIRD were assessed.

RESULTS

SIRD patients had a higher percentage of abnormal ETs compared with the control group, especially exercise hypertensive behaviour, higher oxygen consumption, higher resting heart rate and heart rate at the first minute of recovery, and chronotropic incompetence (C-Inc) (P < 0.001). The disease itself was involved with higher likelihood of having an abnormal ET [Odds ratio (OR) = 12.0, 95% CI: 2.5, 56.7; P = 0.002 for SLE; OR = 13.56, 95% CI: 6.16, 29.8; P < 0.001 for RA; and OR = 4.31, 95% CI: 1.17, 15.8; P = 0.028, for AS]. Each 10-year increment of age increased the chance of having an abnormal ET by 13% (P = 0.008) in AS patients, as well as hypertension (OR = 7.14, 95% CI: 1.61, 31.6; P = 0.01). Regarding C-Inc, age played a protective role (OR = 0.88, 95% CI: 0.78, 0.99; P = 0.043) in SLE, and ASDAS-ESR was associated with a higher risk in AS (OR = 2.73, 95% CI: 0.93, 8.0; P = 0.067).

CONCLUSION

Our results showed a higher prevalence of abnormal ETs in asymptomatic cardiovascular SIRD patients, and the disease itself was associated with a higher likelihood of having an abnormal test, emphasizing the relevance and need of performing it before starting supervised physical exercise.

Atrial electromechanical delay is impaired in patients with psoriasis

OBJECTIVE

In this study, we aimed to investigate atrial electromechanical delay (EMD) in patients with psoriasis.

SUBJECTS AND METHODS

A total of 43 patients with psoriasis (26 mild-moderate, 17 severe) and 17 healthy control subjects were enrolled. Patients with psoriasis were divided into two groups: the mild-moderate group and the severe group according to their psoriasis area severity index (PASI) scores. Atrial EMD was measured from the lateral mitral annulus and called 'PA lateral', from the septal mitral annulus, called 'PA septal', and from the right ventricle tricuspid annulus, called 'PA tricuspid'. Atrial EMD was defined as the time interval from the onset of atrial electrical activity (P wave on surface ECG) to the beginning of mechanical atrial contraction (late diastolic A wave). All three groups were compared with each other, and correlation analysis was performed to investigate the relationship between the PASI score and interatrial EMD.

RESULTS

PA lateral was significantly higher in both the mild-moderate psoriasis group and the severe psoriasis group compared to controls (69 ± 12 and 78 ± 13 vs. 60 ± 6 ms; p = 0.001). Also, PA septal (63 ± 11 vs. 53 ± 6 ms; p = 0.005, post hoc analysis) and PA tricuspid (49 ± 7 vs. 41 ± 5 ms; p = 0.009, post hoc analysis) were significantly higher in the severe psoriasis group than in the control group. Correlation analysis revealed that the PASI score was well correlated with PA lateral (r = 0.520, p < 0.001), PA septum (r = 0.460, p = 0.002), interatrial EMD (r = 0.371, p = 0.014) and intra-atrial EMD (r = 0.393, p = 0.009).

CONCLUSION

Atrial EMD was prolonged in patients with psoriasis. The measurement of atrial EMD might be used to determine the risk of development of AF in patients with psoriasis.

Impaired heart rate recovery indices in psoriasis patients

Background

Psoriasis is a systemic inflammatory disease associated with increased risk of cardiovascular diseases. The heart rate recovery index (HRRI) is an indicator of autonomic nervous system function and is an independent prognostic risk factor for cardiovascular diseases. The aim of this study was to evaluate the heart rate recovery indices in patients with psoriasis.

Material/methods

Thirty-three psoriasis patients (22 male; mean age 41±11 years) and 26 healthy individuals (15 male; mean age 39±11 years) as a control group were included in the study. Baseline electrocardiography, transthoracic echocardiographic examinations, and exercise stress tests were performed in psoriasis and control groups. The heart rate recovery of the psoriasis group at 1, 2, 3, 4, and 5 minutes after maximal exercise were calculated and compared to those of the control group.

Results

Baseline demographic and clinical characteristics of psoriasis and control groups including age, sex, body mass index, systolic blood pressure, and echocardiographic parameters were similar. Total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels were significantly higher and high-density lipoprotein cholesterol levels were significantly lower in the psoriasis group (p<0.05). Heart rate recovery at 1, 2, 3, 4, and 5 minutes after maximal exercise were found to be significantly lower in the psoriasis group (p<0.05). Additionally, baseline heart rates before exercise were significantly higher in the psoriasis group (p<0.05).

Conclusions

We found that impaired HRRI in psoriasis patients, which indicates the underlying autonomic nervous system dysfunction, is a pathophysiologic mechanism for increased cardiovascular disease risk.