Exaggerated local hand sympathetic but not renin-angiotensin system activation in patients with primary Raynaud's phenomenon

Autonomic nervous system activity in primary Raynaud's phenomenon: Heart rate variability, plasma catecholamines and [123 I]MIBG heart scintigraphy

Background and Aim

Primary Raynaud's phenomenon (pRP) is characterized by an exaggerated response to cold, resulting in the whitening typically of the fingers and toes. The patients are generally perceived as healthy individuals with a benign condition. However, the condition has been associated with increased cardiovascular mortality and changes in autonomic nervous system activity. This study aimed to investigate whether pRP is associated with pervasive changes in autonomic nervous activity. The hypothesis was that patients with pRP have increased sympathetic nervous activity.

Methods

The autonomic nervous activity of 22 patients with pRP was investigated by means of heart rate variability (HRV) and the plasma catecholamine response to head‐up tilt and compared with 22 age‐ and gender‐matched controls. In addition, the patients were examined with a [¹²³I]metaiodobenzylguanidine heart scintigraphy and compared with an external control group.

Results

The plasma norepinephrine response to head‐up tilt was significantly lower in the patient group than in the control group. Similarly, the heart scintigraphy revealed a lower heart‐to‐mediastinum ratio in the patient group than in the control group. HRV analysis did not reveal significant differences between the groups.

Conclusion

The findings of the study showed that the autonomic nervous activity of patients with pRP was altered compared with the activity of healthy individuals. This was observed both during rest and after positional stress, but the findings did not uniformly concur with our initial hypothesis.