Is there cardiac autonomic dysfunction

among patients with cystic fibrosis?

E Hatziagorou1, S Giannakoulakos2, E Kouidi2, M

Anifanti2, A Kampouras1, A Deligiannis2, J
Tsanakas1
CF Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
School of Physical Education & Sports Sciences, Aristotle University of Thessaloniki
Background

The interaction between cardiac and pulmonary

dysfunction in CF patients, may influence the
autonomic nervous system controlling the heart.
 HRV Index

Changes in heart rate variability (HRV) patterns are a

sensitive and early indicator of Cardiac Autonomic
Nervous System dysfunction.

PLOS ONE | 2016

Aim

To assess the cardiac autonomic control by heart

rate variability (HRV) analysis in young patients
with Cystic Fibrosis.
To correlate HRV changes with their respiratory
function.
Methods
2. Cardiopulmonary Exercise
1. Spirometry (FEV1) Testing (VO2peak)

19 stable Godfrey Protocol:

young CF A warm-up period of 3 minutes cycling with 20 Watts
patients Work load was increased by 15 W per minute, for 8-
12 min.
Parameters measured:
Peak oxygen uptake (VO2peak)
Ventilator equivalent ratios for oxygen and
carbon dioxide at peak exercise (VE/VO2,
VE/VCO2)
Anaerobic Threshold (AT)
Breathing reserve at peak exercise (BR%)
 Methods
3. HRV Assessment
(24-h Holter monitoring)

TIME DOMAIN MEASURES

Sympatho-vagal balance Standard Deviation of RR Intervals
(SDNN)
Vagal activity Percentage value of RR 50 count
(pNN50)
Square root of the mean of the sum
of the squares of differences
between adjacent RR intervals
(RMSSD)
FREQUENCY DOMAIN ANALYSIS
Sympathetic activity Low Frequency (LF) component
Vagal activity High Frequency (HF) component
Sympatho-vagal balance LF/HF ratio
Population characteristics
Mean, sd / N
(%)
Age, year 14.2 4.2
BMI, kg/m2 19.3 3
BMI z score - 0.41 (1.15)
Weight, kg 48.5 13.2
Weight z score -0.58 (0.18)
Height, cm 157 14
Height z score -0.37 (0.53)
F508, Homozygous 4 (21%)
F508, Heterozygous 10 (52.6%)
Pseudomonas 5 (26%)
Aeruginosa
FEV1 % predicted 92.8 (22.10)
Results

CPET Mean (SD)

VO2peak (L/min) 1.85 (0.53)
VO2peak%(%predicted) 75.81 (7.2)
VD/VT (peak exercise) 0.13 (0.05)
VE/VO2 (peak exercise) 32.88 (5.12)
VE/VCO2 (peak exercise) 33.08 (4.98)
Spirometry
FEV1(L) 2.49 (0.93)
% predicted 92.8 (22.10)
FVC(L) 3.37 (0.97)
% predicted 93.66 (16.70)
FEF25-75 2.38 (1.08)
% predicted 75.03 (24.10)
Results - HRV Measurements

CF Normal
values
Mean SD

HR 82.58 (7.65) 60-100

(beats/min)
SDNN (ms) 98.21 (23.69) >110

pNN50 24.36 (11.75) >32

RMSSD (ms) 64.08 (29.73) >100

LF:HF 2.46 (1.18) <1.5

 Autonomic dysfunction was not correlated
with FEV1 or VO2peak

140 p=0.984 3.5

120 3.0 p=0.958

100 2.5

80 2.0
SDNN

SDNN
60 1.5

40 1.0

20 0.5

0 0.0
50 70 90 110 130 150 50 70 90 110 130 150
FEV1 VOpeak

SDNN correlation with FEV1 & VO2Peak

 Autonomic dysfunction was not correlated
with FEV1 or VO2peak

6 6

5 p= 0.245 5 p=0.135
4 4

LF/HF
LF/HF

3 3

2 2

1 1

0 0
40 50 60 70 80 90 100 110 120 130 140 40 50 60 70 80 90 100 110 120

FEV1 Vopeak

LF/HF correlation with FEV1 & VO2Peak

Conclusions
Patients with mild to moderate CF have
moderately depressed heart rate
variability (HRV) and a shift of sympatho-
vagal balance towards sympathetic
predominance and reduced vagal tone.
Heart rate variability (HRV) was not
correlated with cardio-respiratory
function.
The chronic use of -adrenergic agonists
may attribute to the predominance of
sympathetic activity among patients with
 Acknowledgements
Paediatric Pulmonology and CF Unit, School of Physical
Aristotle University of Thessaloniki Education
& Sports Sciences,
J Tsanakas Aristotle University of
E Hatziagorou Thessaloniki
F Kirvassilis
A Deligiannis
M Galogavrou
E Chrysochoou E Kouidi
V Avramidou M Anifanti
A Kampouras S Giannakoulakos
E Kalaitzidou
K Bakas

CF families