2 Department of Neurology, Royal North Shore Hospital, University of Sydney, Australia. BACK GROUND. ⢠Multiple Sclerosis is associated with autonomic ...
Abstract No. : POA2016-P-04
Non-invasive characterization of cardiovascular autonomic dysfunction in multiple sclerosis Fatemeh Shirbani1, Y C Lee2, K Ng2, J Parratt2, Edward Barin1, Mark Butlin1, Alberto P Avolio1 1
Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia. 2 Department of Neurology, Royal North Shore Hospital, University of Sydney, Australia. RESULTS (CONTINUED)
BACK GROUND
METHODS
• A comprehensive suite of cardiovascular autonomic tests was applied to 53 Multiple Sclerosis patients (48±14 yrs, 34 female) and results associated with clinical markers of Multiple Sclerosis severity. • Cardiac autonomic dysfunction was identified through analysis of continuous electrocardiogram and noninvasive finger blood pressure recording during: • 5-minutes supine rest • short-term deep breathing • Valsalva manoeuvre • orthostatic challenge • isometric exercise.
(A) % total subjects with abnormal response
• Multiple Sclerosis is associated with autonomic nervous system damaged. • Reported cardiovascular autonomic dysfunction prevalence in MS varies between studies. • As cardiac autonomic dysfunction lowers quality of life and may contribute to sudden death in Multiple Sclerosis, early cardiac autonomic dysfunction detection may assist in treatment and in risk identification.
60
Deep breathing HR/BP response ΔHR in Valsalva
50 40
(B)
ΔHR in orthostatic challenge (30:15 ratio) ΔBP in Valsalva
30 20
ΔBP in orthostatic challenge ΔBP in isometric exercise
10 0
parasympathetic responses
(C)
sympathetic responses
(D)
RESULTS • In Multiple Sclerosis subjects, sympathetic impairment (58%) was more prevalent than parasympathetic impairment (34%) (Figure A). • Total brain and spine lesions was correlated with dampened sympathetic response in Valsalva manoeuvre and orthostatic challenge (R2=0.22, p=0.010) (Figure B). • Age corrected score for sympathetic control showed deterioration with longer disease duration (Figure C) and treatment delay>10 years (Figure D).
CONCLUSIONS
• Results indicate a high prevalence of cardiac autonomic dysfunction in Multiple Sclerosis that can be evaluated using non-invasive measures during cardiovascular challenges. • Sympathetic markers may assist in diagnosing disease progression and are exacerbated with delay in treatment.
Abstract No. : POA2016-P-04
Non-invasive characterization of cardiovascular autonomic dysfunction in multiple sclerosis Fatemeh Shirbani1, Y C Lee2, K Ng2, J Parratt2, Edward Barin1, Mark Butlin1, Alberto P Avolio1 1
Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia. 2 Department of Neurology, Royal North Shore Hospital, University of Sydney, Australia. RESULTS (CONTINUED)
BACK GROUND
METHODS
• A comprehensive suite of cardiovascular autonomic tests was applied to 53 Multiple Sclerosis patients (48±14 yrs, 34 female) and results associated with clinical markers of Multiple Sclerosis severity. • Cardiac autonomic dysfunction was identified through analysis of continuous electrocardiogram and noninvasive finger blood pressure recording during: • 5-minutes supine rest • short-term deep breathing • Valsalva manoeuvre • orthostatic challenge • isometric exercise.
(A) % total subjects with abnormal response
• Multiple Sclerosis is associated with autonomic nervous system damaged. • Reported cardiovascular autonomic dysfunction prevalence in MS varies between studies. • As cardiac autonomic dysfunction lowers quality of life and may contribute to sudden death in Multiple Sclerosis, early cardiac autonomic dysfunction detection may assist in treatment and in risk identification.
60
Deep breathing HR/BP response ΔHR in Valsalva
50 40
(B)
ΔHR in orthostatic challenge (30:15 ratio) ΔBP in Valsalva
30 20
ΔBP in orthostatic challenge ΔBP in isometric exercise
10 0
parasympathetic responses
(C)
sympathetic responses
(D)
RESULTS • In Multiple Sclerosis subjects, sympathetic impairment (58%) was more prevalent than parasympathetic impairment (34%) (Figure A). • Total brain and spine lesions was correlated with dampened sympathetic response in Valsalva manoeuvre and orthostatic challenge (R2=0.22, p=0.010) (Figure B). • Age corrected score for sympathetic control showed deterioration with longer disease duration (Figure C) and treatment delay>10 years (Figure D).
CONCLUSIONS
• Results indicate a high prevalence of cardiac autonomic dysfunction in Multiple Sclerosis that can be evaluated using non-invasive measures during cardiovascular challenges. • Sympathetic markers may assist in diagnosing disease progression and are exacerbated with delay in treatment.
