GENÇ YETİŞKİN ÇÖLYAK HASTALARINDA BOZULMUŞ KALP HIZI DEĞİŞKENLİĞİ OTONOMİK BOZUKLUK VE ARTMIŞ KARDİYOVASKÜLER RİSK

Öz

Amaç: Çölyak Hastalığı, her yaşta çeşitli semptomlarla ortaya çıkabilen yaygın bir otoimmün hastalıktır. Vasküler ve aritmik bozuklukları içeren kalp tutulumu, otoimmün bozukluğu olan hastalarda önemli bir prognostik değere sahiptir. Bu çalışmanın amacı, kalp hızı değişkenliği (KHD) parametrelerini ölçerek, çölyak hastalığının kardiyovasküler otonomik fonksiyonlar üzerindeki etkilerini değerlendirmektir. Gereç ve Yöntemler: Doksan bir çölyak hastası ve doksan üç sağlıklı gönüllü çalışmaya dahil edildi. 24 saatlik ayaktan elektrokardiyografi ile ölçülen kalp hızı değişkenliğinin hem zaman alanı hem de frekans alanı endekslerini inceledik. Bulgular: Düşük frekanslı güç ve düşük frekans-yüksek frekans oranı hariç tüm zaman alanı ve frekans alanı KHD parametreleri, kontrole kıyasla çölyak hastalarında önemli ölçüde daha düşüktü (p < 0.01). Bu fark, gündüz ve gece KHD parametreleri ayrı ayrı karşılaştırıldığında, KHD parametrelerinin çoğu için korunmuştur. Korelasyon analizi, KHD parametrelerinin hemoglobin ve ferritin seviyeleri ve hastalık süresi ile önemli ilişkilerini ortaya çıkardı (p < 0.01). KHD parametreleri ile hastalığın aktivitesine işaret eden anti-doku transglutaminaz IgA ve IgG seviyeleri arasında korelasyon bulunmadı. Sonuç: Çalışma, çölyaklı hastaların KHD’Yİ azalttığını doğruladı, bu da objektif otonomik disfonksiyon ve artmış kardiyovasküler riskin varlığına işaret etmektedir.

Anahtar Kelimeler

• otonom disfonksiyon
• çölyak hastalığı
• kalp hızı değişkenliği

HEART RATE VARIABILITY IS AFFECTED IN YOUNG ADULT CELIAC PATIENTS, INDICATING AUTONOMIC DYSFUNCTION AND INCREASED CARDIOVASCULAR RISK

Öz

Aim: Celiac Disease (CD) is a common autoimmune disease that can present at any age with varied symptoms. Cardiac involvement including vascular and arrhythmic disturbances has an important prognostic value in patients with autoimmune disorders. The aim of this study was to evaluate the effects of CD on cardiovascular autonomic functions by measuring the indices of heart rate variability (HRV). Materials and Methods: Ninety-one CD patients and the ninety-three healthy volunteers were included in the study. We examined both time domain and frequency domain indices of HRV measured by 24-hour ambulatory electrocardiography. Results: All of the time domain and frequency domain HRV parameters, with the exceptions of low frequency power and low frequency to high frequency ratio, were significantly lower in patients with CD compared to the control (p < 0.01). This difference retained for most of the HRV parameters when daytime and nighttime HRV parameters were compared separately. Correlation analysis revealed significant associations of HRV parameters with hemoglobin and ferritin levels and with duration of CD (p < 0.01). No correlation was found between HRV parameters and anti-tissue transglutaminase IgA and IgG levels which indicate the activity of the disease. Conclusion: The study confirmed that patients with CD have reduced HRV, indicating the presence of objective autonomic dysfunction and increased cardiovascular risk.

Anahtar Kelimeler

• autonomic dysfunction
• Celiac disease
• heart rate variability

Teşekkür

We owe MD, Assoc Prof. IO a dept of gratitude and we would like to thank him for referring and providing us guidance for patients with celiac disease.

Kaynakça

1. 1. Rubio-Tapia A, Murray JA. Celiac disease. Curr Opin Gastroenterol. 2010;26(2):116-122.
2. 2. Mormile R. Celiac disease and atherosclerosis: An immunologic puzzle to be solved? Immunol Lett. 2016;180:75-76.
3. 3. De Marchi S, Chiarioni G, Prior M, Arosio E. Young adults with coeliac disease may be at increased risk of early atherosclerosis. Aliment Pharmacol Ther. 2013;38(2):162-169.
4. 4. Ciaccio EJ, Lewis SK, Biviano AB, et al. Cardiovascular involvement in celiac disease. World J Cardiol. 2017;9(8):652-666.
5. 5. Buéno L, Fioramonti J, Garcia-Villar R. Pathobiology of visceral pain: molecular mechanisms and therapeutic implications. III. Visceral afferent pathways: a source of new therapeutic targets for abdominal pain. Am J Physiol Gastrointest Liver Physiol. 2000;278(5):G670-676.
6. 6. Giorgetti GM, Tursi A, Iani C, et al. Assessment of autonomic function in untreated adult coeliac disease. World J Gastroenterol. 2004;10(18):2715-2718.
7. 7. Nolan J, Batin PD, Andrews R, et al. Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). Circulation. 1998;98(15):1510-1516.
8. 8. Huikuri HV, Stein PK. Clinical application of heart rate variability after acute myocardial infarction. Front Physiol. 2012;3:41.

9. 9. Sessa F, Anna V, Messina G, et al. Heart rate variability as predictive factor for sudden cardiac death. Aging (Albany NY). 2018;10(2):166-177.
10. 10. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93(5):1043-1065.
11. 11. Chin RL, Latov N. Peripheral Neuropathy and Celiac Disease. Curr Treat Options Neurol. 2005 Jan;7(1):43-48.
12. 12. Hadjivassiliou M, Grünewald RA, Kandler RH, et al. Neuropathy associated with gluten sensitivity. J Neurol Neurosurg Psychiatry. 2006 Nov;77(11):1262-6.
13. 13. Penny HA, Aziz I, Ferrar M, et al. Coeliac Disease is More Common in Subjects with Postural Orthostatic Tachycardia Syndrome Compared to Healthy Controls. Gut. 2016;65:165-166.
14. 14. Usai P, Usai Satta P, Lai M, et al. Bassotti G. Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease. Eur J Clin Invest. 1997;27(12):1009-1015.
15. 15. Przybylska-Felus M, Furgala A, Zwolinska-Wcislo M, et al. Disturbances of autonomic nervous system activity and diminished response to stress in patients with celiac disease. J Physiol Pharmacol. 2014;65(6):833-841.
16. 16. Kuusela T. Methodological aspects of heart rate variability analysis. In: Kamath MV, Watanabe MA, Upton ARM, editors. Heart Rate Variability (HRV) Signal Analysis. Boca Raton, FL: CRC Press .2013; 9–42.
17. 17. Shaffer F, McCraty R, Zerr CL. A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability. Front Psychol. 2014;5:1040.
18. 18. Colivicchi F, Bassi A, Santini M, Caltagirone C. Cardiac autonomic derangement and arrhythmias in right-sided stroke with insular involvement. Stroke. 2004;35(9):2094-2098.
19. 19. Dekker JM, Crow RS, Folsom AR, et al. Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC Study. Atherosclerosis Risk In Communities. Circulation. 2000;102(11):1239-1244.
20. 20. Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain. Circulation. 1991;84(2):482-92.
21. 21. Billman GE. The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance. Front Physiol. 2013;4:26.
22. 22. Taylor JA, Myers CW, Halliwill JR, et al. Sympathetic restraint of respiratory sinus arrhythmia: implications for vagal-cardiac tone assessment in humans. Am J Physiol Heart Circ Physiol. 2001;280(6):H2804-2814.
23. 23. Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health. 2017 Sep 28;5:258.
24. 24. Mayassi T, Ladell K, Gudjonson H, et al. Chronic Inflammation Permanently Reshapes Tissue-Resident Immunity in Celiac Disease. Cell. 2019;176(5):967-981.
25. 25. Luostarinen L, Himanen SL, Luostarinen M, et al. Neuromuscular and sensory disturbances in patients with well treated coeliac disease. J Neurol Neurosurg Psychiatry. 2003;74(4):490-494.
26. 26. Wen TL, Chung-Kwe W, Yang IF, Yang TF. Relationship between electrolytes and heart rate variability parameters in end-stage renal failure patients before and after hemodialysis. Anadolu Kardiyol Derg. 2007;7 (Suppl 1):142-4.
27. 27. Gehi A, Ix J, Shlipak M, et al. Relation of anemia to low heart rate variability in patients with coronary heart disease (from the Heart and Soul study). Am J Cardiol. 2005;95(12):1474-1477.
28. 28. Yokusoglu M, Nevruz O, Baysan O, et al. The altered autonomic nervous system activity in iron deficiency anemia. Tohoku J Exp Med. 2007;212(4):397-402.