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Central Autonomic Dysfunction Delays Recovery of Fingolimod Induced Heart Rate Slowing.

Hilz MJ, Intravooth T, Moeller S, Wang R, Lee DH, Koehn J, Linker RA - PLoS ONE (2015)

Bottom Line: They did not reduce parasympathetic HR-parameters upon standing-up.After Valsalva-strain-release, their parasympathetic HR-slowing in response to BP-overshoot was four times higher than in the other participants (p<0.05).The autonomic cardiovascular dysfunction in MS-patients with delayed HR-re-acceleration upon Fingolimod-initiation suggests that MS-related central autonomic lesions compromise HR-re-acceleration upon Fingolimod.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.

ABSTRACT

Background: In multiple sclerosis (MS) patients, Fingolimod may induce prolonged heart-rate slowing which might be caused by MS-related central autonomic lesions.

Objectives: To evaluate whether MS-patients with prolonged heart-rate slowing (> six hours) upon Fingolimod show cardiovascular-autonomic dysfunction before Fingolimod-initiation.

Methods: Before Fingolimod-initiation, we recorded electrocardiographic RR-intervals (RRIs) and blood-pressure (BP) at rest, upon standing-up, during metronomic deep-breathing, Valsalva-maneuver, and "sustained-handgrip-exercise" in 21 patients with relapsing-remitting MS, and 20 healthy persons. We calculated sympathetic and parasympathetic cardiovascular parameters, including low- (LF) and high-frequency (HF) powers of RRI- and BP-oscillations, RRI-RMSSDs, RRI- and BP-changes during handgrip-exercise, parasympathetic heart-rate-slowing in relation to BP-overshoot after Valsalva-strain-release. We compared values of healthy persons and patients with and without prolonged heart-rate slowing after Fingolimod-initiation (ANOVA; significance: p<0.05).

Results: Upon Fingolimod-initiation, 7/21 patients had prolonged HR-slowing. Before Fingolimod, these patients had higher resting BP and higher BP increase during handgrip-exercise than had the other participants (p<0.05). They did not reduce parasympathetic HR-parameters upon standing-up. After Valsalva-strain-release, their parasympathetic HR-slowing in response to BP-overshoot was four times higher than in the other participants (p<0.05).

Conclusions: The autonomic cardiovascular dysfunction in MS-patients with delayed HR-re-acceleration upon Fingolimod-initiation suggests that MS-related central autonomic lesions compromise HR-re-acceleration upon Fingolimod.

Trial registration: German Clinical Trial Register DRKS00004548 http://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_EN.do.

No MeSH data available.


Related in: MedlinePlus

Flowchart of study patients.
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pone.0132139.g001: Flowchart of study patients.

Mentions: 21 patients (12 women; mean age 34.4 years, standard deviation [SD] 6.6 years) with relapsing-remitting MS participated in the study (Fig 1). Cardiovascular autonomic modulation at rest and during autonomic challenge maneuvers, immediately before Fingolimod-initiation was compared to that of 20 age-matched healthy volunteers (10 women; mean age, 30.1±12.5 years). Table 1 summarizes demographic data of patients and healthy persons.


Central Autonomic Dysfunction Delays Recovery of Fingolimod Induced Heart Rate Slowing.

Hilz MJ, Intravooth T, Moeller S, Wang R, Lee DH, Koehn J, Linker RA - PLoS ONE (2015)

Flowchart of study patients.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493029&req=5

pone.0132139.g001: Flowchart of study patients.
Mentions: 21 patients (12 women; mean age 34.4 years, standard deviation [SD] 6.6 years) with relapsing-remitting MS participated in the study (Fig 1). Cardiovascular autonomic modulation at rest and during autonomic challenge maneuvers, immediately before Fingolimod-initiation was compared to that of 20 age-matched healthy volunteers (10 women; mean age, 30.1±12.5 years). Table 1 summarizes demographic data of patients and healthy persons.

Bottom Line: They did not reduce parasympathetic HR-parameters upon standing-up.After Valsalva-strain-release, their parasympathetic HR-slowing in response to BP-overshoot was four times higher than in the other participants (p<0.05).The autonomic cardiovascular dysfunction in MS-patients with delayed HR-re-acceleration upon Fingolimod-initiation suggests that MS-related central autonomic lesions compromise HR-re-acceleration upon Fingolimod.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.

ABSTRACT

Background: In multiple sclerosis (MS) patients, Fingolimod may induce prolonged heart-rate slowing which might be caused by MS-related central autonomic lesions.

Objectives: To evaluate whether MS-patients with prolonged heart-rate slowing (> six hours) upon Fingolimod show cardiovascular-autonomic dysfunction before Fingolimod-initiation.

Methods: Before Fingolimod-initiation, we recorded electrocardiographic RR-intervals (RRIs) and blood-pressure (BP) at rest, upon standing-up, during metronomic deep-breathing, Valsalva-maneuver, and "sustained-handgrip-exercise" in 21 patients with relapsing-remitting MS, and 20 healthy persons. We calculated sympathetic and parasympathetic cardiovascular parameters, including low- (LF) and high-frequency (HF) powers of RRI- and BP-oscillations, RRI-RMSSDs, RRI- and BP-changes during handgrip-exercise, parasympathetic heart-rate-slowing in relation to BP-overshoot after Valsalva-strain-release. We compared values of healthy persons and patients with and without prolonged heart-rate slowing after Fingolimod-initiation (ANOVA; significance: p<0.05).

Results: Upon Fingolimod-initiation, 7/21 patients had prolonged HR-slowing. Before Fingolimod, these patients had higher resting BP and higher BP increase during handgrip-exercise than had the other participants (p<0.05). They did not reduce parasympathetic HR-parameters upon standing-up. After Valsalva-strain-release, their parasympathetic HR-slowing in response to BP-overshoot was four times higher than in the other participants (p<0.05).

Conclusions: The autonomic cardiovascular dysfunction in MS-patients with delayed HR-re-acceleration upon Fingolimod-initiation suggests that MS-related central autonomic lesions compromise HR-re-acceleration upon Fingolimod.

Trial registration: German Clinical Trial Register DRKS00004548 http://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_EN.do.

No MeSH data available.


Related in: MedlinePlus