Patterns of cardiovascular reactivity in disease diagnosis

• Published in: QJM : An International Journal of Medicine 2004-03, Vol.97 (3), p.141-151
• Main Authors: Naschitz, J.E., Rosner, I., Rozenbaum, M., Fields, M., Isseroff, H., Babich, J.P., Zuckerman, E., Elias, N., Yeshurun, D., Naschitz, S., Sabo, E.
• Format: Article
• Language: English
• Subjects: Adult; Arthritis, Psoriatic - diagnosis; Arthritis, Psoriatic - physiopathology; Biological and medical sciences; Diagnosis, Differential; Familial Mediterranean Fever - diagnosis; Familial Mediterranean Fever - physiopathology; Fatigue - diagnosis; Fatigue - physiopathology; Fatigue Syndrome, Chronic - diagnosis; Fatigue Syndrome, Chronic - physiopathology; Female; Fractals; General aspects; Heart Rate; Humans; Male; Medical sciences; Middle Aged; Pulse; Signal Processing, Computer-Assisted; Syncope, Vasovagal - diagnosis; Syncope, Vasovagal - physiopathology; Tilt-Table Test
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/hch032

Background: Aberrations of cardiovascular reactivity (CVR), an expression of autonomic function, occur in a number of clinical conditions, but lack specificity for a particular disorder. Recently, a CVR pattern particular to chronic fatigue syndrome was observed. Aim: To assess whether specific CVR patterns can be described for other clinical conditions. Methods: Six groups of patients, matched for age and gender, were evaluated with a shortened head-up tilt test: patients with chronic fatigue syndrome (CFS) (n = 20), non-CFS fatigue (F) (n = 15), neurally-mediated syncope (SY) (n = 21), familial Mediterranean fever (FMF) (n = 17), psoriatic arthritis (PSOR) (n = 19) and healthy subjects (H) (n = 20). A 10-min supine phase was followed by recording 600 cardiac cycles on tilt (5–10 min). Beat-to-beat heart rate (HR) and pulse transit time (PTT) were measured. Results were analysed using conventional statistics, recurrence plot analysis and fractal analysis. Results: Multivariate analysis evaluated independent predictors of the CVR in each patient group vs. all other groups. Based on these predictors, equations were determined for a linear discriminant score (DS) for each group. The best sensitivities and specificities of the DS, consistent with disease-related phenotypes of CVR, were noted in the following groups: CFS, 90.0% and 60%; SY, 93.3% and 62.5%; FMF, 90.1% and 75.4%, respectively. Discussion: Pathological disturbances may alter cardiovascular reactivity. Our data support the existence of disease-related CVR phenotypes, with implications for pathogenesis and differential diagnosis.