Значение вариабельности ритма сердца при ревматоидном артрите

Ревматоидный артрит (РА) – хроническое системное аутоиммунное заболевание. Одной из основных причин смерти при РА являются сердечно-сосудистые катастрофы. Несмотря на это, методика оценки риска сердечно-сосудистых осложнений, при которой учитывались бы клинические и патогенетические особенности РА, до настоящего момента не разработана. В обзоре рассматриваются вопросы связи кардиальной автономной нейропатии (КАН) и вариабельности ритма сердца (ВРС) с сердечно-сосудистыми заболеваниями (ССЗ). Также большое внимание уделено значению и распространенности КАН среди пациентов с РА. Представлена информация о влиянии воспаления и терапии РА на течение КАН и показатели ВРС. Накопленная информация дает возможность рассматривать ВРС как перспективный дополнительный метод оценки тяжести поражения органов-мишеней, рисков ССЗ, а также эффективности терапии у больных РА. Однако для разработки рекомендаций по применению оценки ВРС при РА требуется проведение дополнительных исследований.

1. Насонов ЕЛ, Каратеев ДЕ, Балабанова РМ. Ревматоидный артрит. В кн.: Ревматология. Национальное руководство. Под.ред. Е.Л. Насонова, В.А. Насоновой. Москва: ГЭОТАР-Медиа; 2008. С. 290–331 [Nasonov EL, Karateev DE, Balabanova RM. Rheumatoid arthritis. In: Revmatologiya. Natsional'noe rukovodstvo [Rheumatology. National Guide]. Nasonov EL, Nasonova VA, editors. Moscow: GEOTAR-Media; 2008. P. 290–331].

2. Weinblatt ME, Kuritzky L. RAPID: rheumatoid arthritis. J Fam Pract. 2007;56:S1–7.

3. Попкова ТВ, Новикова ДС, Насонов ЕЛ. Атеросклероз при ревматических заболеваниях. В кн.: Насонов ЕЛ, редактор. Ревматология: клинические рекомендации. Москва: ГЭОТАР-Медиа; 2010; С. 678–702 [Popkova TV, Novikova DS, Nasonov EL. Atherosclerosis in rheumatic diseases. In: Nasonov EL, editor. Revmatologiya: klinicheskie rekomendatsii [Rheumatology: clinical guidelines]. Moscow: GEOTAR-Media; 2010; P. 678–702].

4. Ениг В. Вегетативная нервная система. В кн.: Шмидт Р, Тевс Г, редакторы. Физиология человека. 2-е изд. Москва: Мир; 1996. С. 343–55 [Enig V. Vegetative nervous system. In: Shmidt R, Tevs G, editors. Fiziologiya cheloveka [Human physiology]. 2nd ed. Moscow: Mir; 1996. P. 343–55].

5. Suarez GA, Low PA. Acute and chronic autonomic neuropathies. In: Immunological and Infectious Diseases of the Peripheral Nerves. Latov N, Wokke JHJ, Kelly J, editors. Cambridge: Cambridge University Press; 1998. P. 143–57.

6. Boulton JM, Vinic AI, Arezzo JC, et.al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005;28:956–62. doi: 10.2337/diacare.28.4.956

7. Vinic AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115:387–97. doi.org/10.1161/CIRCULATIONAHA. 106.634949

8. Thayer JF, Yamamoto SS, Brosschot JF. The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol. 2010 May 28;141(2):122–31. doi: 10.1016/j.ijcard.2009.09.543. Epub 2009 Nov 11.

9. Greiser KH, Kluttig A, Schumann B, et al. Cardiovascular diseases, risk factors and short-term heart rate variability in an elderly general population: the CARLA study 2002-2006. Eur J Epidemiol. 2009;24(3):123–42. doi.org/10.1007/s10654-009-9317-z. Epub 2009 Feb 7.

10. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiolology. Heart rate variability. Standards of measurements, physiological interpretation and clinical use. Circulation. 1996;93:1043–65. doi: 10.1161/01.CIR.93.5.1043

11. Felber Dietrich D, Schindler C, Schwartz J, et al.; SAPALDIA Team. Heart rate variability in an ageing population and its association with lifestyle and cardiovascular risk factors: results of the SAPALDIA study. Europace. 2006 Jul;8(7):521–9. doi: 10.1093/europace/eul063

12. Munk PS, Butt N, Larsen AI. High-intensity interval exercise training improves heart rate variability in patients following percutaneous coronary intervention for angina pectoris. Int J Cardiol. 2010 Nov 19;145(2):312–4. Epub 2009 Dec 5. doi: 10.1016/j.ijcard.2009.11.015

13. Lombardi F, Porta A, Marzegalli M, et al.; Implantable Cardioverter Defibrillator-Heart Rate Variability Italian Study Group. Heart rate variability patterns before ventricular tachycardia onset in patients with an implantable cardioverter defibrillator. Participating Investigators of ICD-HRV Italian Study Group. Am J Cardiol. 2000 Nov 1;86(9):959–63. doi: 10.1016/S0002-9149(00)01130-9

14. Zipes DP, Rubart M. Neural modulation of cardiac arrhythmias and sudden cardiac death. Heart Rhythm. 2006;3:108–13. doi: 10.1016/j.hrthm.2005.09.021

15. Довгалевский ПЯ, Рыбак ОК, Фурман НВ. Показатели вариабельности ритма сердца у больных ишемической болезнью сердца в зависимости от тяжести атеросклероза коронарных артерий (по данным селективной коронарографии) и функционального класса стенокардии. Кардиология. 2002;42(9):17–20 [Dovgalevskii PYa, Rybak OK, Furman NV. Heart rate variability in patients with coronary heart disease, depending on the severity of coronary atherosclerosis (according to selective coronary angiography) and functional class of angina. Kardiologiya = Cardiology. 2002;42(9):17–20 (In Russ.)].

16. Celik A, Ozturk A, Ozbek K, et al. Heart rate variability and turbulence to determine true coronary artery disease in patients with ST segment depression without angina during exercise stress testing. Clin Invest Med. 2011 Dec 1;34(6):E349.

17. Wennerblom B, Lurje L, Tygesen H, et al. Patients with uncomplicated coronary artery disease have reduced heart rate variability mainly affecting vagal tone. Heart. 2000 Mar;83(3):290–4. doi: 10.1136/heart.83.3.290

18. Burger AJ, Charlamb M, Sherman HB. Circadian patterns of heart rate variability in normals, chronic stable angina and diabetes mellitus. Int J Cardiol. 1999 Sep 30;71(1):41–8. doi: 10.1016/S0167-5273(99)00110-2

19. Nolan J, Flapan AD, Reid J, et al. Cardiac parasympathetic activity in severe uncomplicated coronary artery disease. Br Heart J. 1994 Jun;71(6):515–20. doi: 10.1136/hrt.71.6.515

20. Kacem K, Bonvento G, Seylaz J. Effect of sympathectomy on the phenotype of smooth muscle cells of middle cerebral and ear arteries of hyperlipidaemic rabbits. Histochem J. 1997;29:279–86. doi: 10.1023/A:1026418413313

21. Lanza GA, Cianflone D, Rebuzzi AG, et al.; Stratificazione Prognostica dell'Angina Instabile Study Investigators. Prognostic value of ventricular arrhythmias and heart rate variability in patients with unstable angina. Heart. 2006 Aug;92(8):1055–63. doi: 10.1136/hrt.2005.070714. Epub 2005 Dec 30.

22. Lanza GA, Pedrotti P, Rebuzzi AG, et al. Usefulness of the addition of heart rate variability to Holter monitoring in predicting inhospital cardiac events in patients with unstable angina pectoris. Am J Cardiol. 1997 Aug 1;80(3):263–7. doi: 10.1016/S0002-9149(97)00343-3

23. La Rovere MT, Bigger JT Jr, Marcus FI, et al. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet. 1998 Feb 14;351(9101):478–84. doi: 10.1016/S0140-6736(97)11144-8

24. Tapanainen JM, Thomsen PE, Kober L, et al. Fractal analysis of heart rate variability and mortality after an acute myocardial infarction. Am J Cardiol. 2002 Aug 15;90(4):347–52. doi: 10.1016/S0002-9149(02)02488-8

25. Galinier M, Pathak A, Fourcade J, et al. Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic heart failure. Eur Heart J. 2000 Mar;21(6):475–82. doi: 10.1053/euhj.1999.1875

26. 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 Oct 13;98(15):1510–6. doi: 10.1161/01.CIR.98.15.1510

27. Bilchick KC, Fetics B, Djoukeng R, et al. Prognostic value of heart rate variability in chronic congestive heart failure (Veterans Affairs’ Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure). Am J Cardiol. 2002 Jul 1;90(1):24–8. doi: 10.1016/S0002- 9149(02)02380-9

28. Virtanen R, Jula A, Kuusela T, et al. Reduced heart rate variability in hypertension: associations with lifestyle factors and plasma renin activity. J Hum Hypertens. 2003 Mar;17(3):171–9. doi: 10.1038/sj.jhh.1001529

29. Рябыкина ГВ, Чазова ИЕ, Мычка ВБ и др. Динамика вариабельности ритма сердца при лечении артериальной гипертонии. Кардиология 2008;48(7):18–24 [Ryabykina GV, Chazova IE, Mychka VB, et al. The dynamics of heart rate variability in the treatment of hypertension. Kardiologiya = Cardiology. 2008;48(7):18–24 (In Russ.)].

30. Niemelä MJ, Airaksinen KE, Huikuri HV. Effect of beta-blockade on heart rate variability in patients with coronary artery disease. J Am Coll Cardiol. 1994 May;23(6):1370–7. doi: 10.1016/0735-1097(94)90379-4

31. Wennerblom B, Lurje L, Westberg S, et al. Effects on heart rate variability of isosorbide-5-mononitrate and metoprolol in patients with recent onset of angina pectoris. Cardiology. 1998;89(2):87–93. doi: 10.1159/000006762

32. Melenovsky V, Wichterle D, Simek J, et al. Effect of atorvastatin and fenofibrate on autonomic tone in subjects with combined hyperlipidemia. Am J Cardiol. 2003 Aug 1;92(3):337–41. doi: 10.1016/S0002-9149(03)00643-X

33. Pehlivanidis AN, Athyros VG, Demitriadis DS, et al. Heart rate variability after long-term treatment with atorvastatin in hypercholesterolaemic patients with or without coronary artery disease.Atherosclerosis. 2001 Aug;157(2):463–9. doi: 10.1016/S0021- 9150(00)00746-2

34. Kontopoulos AG, Athyros VG, Papageorgiou AA, et al. Effect of angiotensin-converting enzyme inhibitors on the power spectrum of heart rate variability in post-myocardial infarction patients. Coron Artery Dis. 1997 Aug-Sep;8(8–9):517–24.

35. Karas M, Lacourciеre Y, LeBlanc AR, et al. Effect of the reninangiotensin system or calcium channel blockade on the circadian variation of heart rate variability, blood pressure and circulating catecholamines in hypertensive patients. J Hypertens. 2005 Jun;23(6):1251–60. doi: 10.1097/01.hjh.0000170389.69202.53

36. Vaile JC, Chowdhary S, Osman F, et al. Effects of angiotensin II (AT1) receptor blockade on cardiac vagal control in heart failure. Clin Sci (Lond). 2001 Dec;101(6):559–66. doi: 10.1042/cs1010559

37. Veerman DP, Douma CE, Jacobs MC, et al. Effects of acute and chronic angiotensin converting enzyme inhibition by spirapril on cardiovascular regulation in essential hypertensive patients. Assessment by spectral analysis and haemodynamic measurements. Br J Clin Pharmacol. 1996 Jan;41(1):49–56. doi: 10.1111/j.1365- 2125.1996.tb00158.x

38. Heusser K, Vitkovsky J, Schmieder RE, et al. AT1 antagonism by eprosartan lowers heart rate variability and baroreflex gain. Auton Neurosci. 2003 Aug 29;107(1):45–51. doi: 10.1016/S1566- 0702(03)00053-5

39. Buch AN, Chowdhary S, Coote JH, Townend JN. Effects of nitroglycerin treatment on cardiac autonomic control in heart failure. Clin Auton Res. 2004 Feb;14(1):9–14. doi: 10.1007/s10286-004-0143-9

40. Sahin I, Kosar F, Altunkan S, Gü naydin M. Comparison of the effects of amlodipine and verapamil on autonomic activity in hypertensive patients. Eur J Intern Med. 2004 Jul;15(4):225–30. doi: 10.1016/j.ejim.2004.04.005

41. Vaage-Nilsen M, Rasmussen V. Effect of verapamil on heart rate variability after an acute myocardial infarction. Danish Verapamil Infarction Trial II. Cardiovasc Drugs Ther. 1998 Jul;12(3):285–90. doi: 10.1023/A:1007769800723

42. Schweizer MW, Brachmann J, Kirchner U, et al. Heart rate variability in time and frequency domains: effects of gallopamil, nifedipine, and metoprolol compared with placebo. Br Heart J. 1993 Sep;70(3):252–8. doi: 10.1136/hrt.70.3.252

43. Zaliunas R, Brazdzionyte J, Zabiela V, Jurkevicius R. Effects of amlodipine and lacidipine on heart rate variability in hypertensive patients with stable angina pectoris and isolated left ventricular diastolic dysfunction. Int J Cardiol. 2005 Jun 8;101(3):347–53. doi: 10.1016/j.ijcard.2004.03.040

44. Anichkov DA, Shostak NA, Ivanov DS. Heart rate variability is related to disease activity and smoking in rheumatoid arthritis patients. Int J Clin Pract. 2007 May;61(5):777–83. doi.org/10.1111/j.1742-1241.2006.01099.x. Epub 2007 Mar 16.

45. Новикова ДС, Попкова ТВ, МаркеловаЕИ и др. Клиническое значение оценки вариабельности ритма сердца у больных ревматоидным артритом. Клиническая медицина. 2009;(1):27–32 [Novikova DS, Popkova TV, Markelova EI, et al. The clinical significance of heart rate variability in patients with rheumatoid arthritis. Klinicheskaya meditsina = Clinical Medicine. 2009;(1):27–32 (In Russ.)].

46. Новикова ДС, Попкова ТВ, Лисицына ТА, Насонов ЕЛ. Перспективы определения вариабельности ритма сердца и длительности интервала QT при ревматоидном артрите и системной красной волчанке. Научно-практическая ревматология. 2010;48(5):54–67 [Novikova DS, Popkova TV, Lisitsyna TA, Nasonov EL. Prospects for determining heart rate variability and QT interval duration in rheumatoid arthritis and systemic lupus erythematosus. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2010;48(5):54–67 (In Russ.)].

47. Janse van Rensburg DC, Ker JA, Grant CC, Fletcher L. Autonomic impairment in rheumatoid arthritis. Int J Rheum Dis. 2012 Aug;15(4):419–26. doi: 10.1111/j.1756-185X.2012.01730.x. Epub 2012 Apr 27.

48. Novikova DS, Popkova TV, Udachkina EV, et al. Heart rate variability and QT interval parameters as indicators of cardiovascular risk in patients with rheumatoid arthritis. Ann Rheum Dis. 2011;70 (Suppl 3):446.

49. Udachkina EV, Novikova DS, Popkova TV, et al. Tocilizumab therapy resulted in significantly increased heart rate variability and improved lipid profile in patients with rheumatoid arthritis. Authors Ann Rheum Dis. 2013;72(Suppl3):880. doi: 10.1136/annrheumdis-2013-eular.2628

50. Gao C, Liu X, Shi H, et al. Relationship between sympathetic nervous activity and inflammatory response after subarachnoid hemorrhage in a perforating canine model. Auton Neurosci. 2009 May 11;147(1–2):70–4. doi: 10.1016/j.autneu.2009.01.010. Epub 2009 Feb 13.

51. Dunn AJ, Wang J, Ando T. Effects of cytokines on cerebral neurotransmission. Comparison with the effects of stress. Adv Exp Med Biol. 1999;461:117–27. doi: 10.1007/978-0-585-37970-8_8

52. Koopman FA, Stoof SP, Straub RH, et al. Restoring the balance of the autonomic nervous system as an innovative approach to the treatment of rheumatoid arthritis. Mol Med. 2011 Sep-Oct;17(9–10):937–48. doi: 10.2119/molmed.2011.00065. Epub 2011 May 20.

53. Huston JM, Rosas-Ballina M, Xue X, et al. Cholinergic neural signals to the spleen down-regulate leukocyte trafficking via CD11b. J Immunol. 2009 Jul 1;183(1):552–9. doi: 10.4049/jimmunol.0802684

54. Bruchfeld A, Goldstein RS, Chavan S, et al. Whole blood cytokine attenuation by cholinergic agonists ex vivo and relationship to vagus nerve activity in rheumatoid arthritis. J Intern Med. 2010 Jul;268(1):94–101. doi: 10.1111/j.1365-2796.2010.02226.x. Epub 2010 Feb 18.

55. Van Maanen MA, Vervoordeldonk MJ, Tak PP. The cholinergic anti-inflammatory pathway: towards innovative treatment of rheumatoid arthritis. Nat Rev Rheumatol. 2009 Apr;5(4):229–32. doi: 10.1038/nrrheum.2009.31

56. Syngle A, Verma I, Krishan P, et al. Disease-modifying anti-rheumatic drugs improve autonomic neuropathy in arthritis: DIANA study. Clin Rheumatol. 2014 Jun 15 [Epub ahead of print].

57. Новикова ДС, Попкова ТВ, Герасимова ЕВ и др. Динамика частоты сердечных сокращений, показателей вариабельности ритма сердца и величины интервала Q–T у женщин с ревматоидным артритом на фоне лечения ритуксимабом. Научно-практическая ревматология. 2014;52(3):270–6 [Novikova DS, Popkova TV, Gerasimova EV, et al. Changes in heart rate, heart rate variability and QT interval in women with rheumatoid arthritis during rituximab treatment. Nauchno-prakticheskaya revmatologiya = heumatology Science and Practice. 2014;52(3):270–6 (InRuss.)]. doi: 10.14412/1995-4484-2014-270-276

58. Holman AJ, Ng E. Heart rate variability predicts anti-tumor necrosis factor therapy response for inflammatory arthritis. Auton Neurosci. 2008 Dec 5;143(1–2):58–67. doi: 10.1016/j.autneu. 2008.05.005. Epub 2008 Jul 16.

59. Lazzerini PE, Acampa M, Hammoud M, et al. Arrhythmic risk during acute infusion of infliximab: a prospective, single-blind, placebo-controlled, crossover study in patients with chronic arthritis. J Rheumatol. 2008 Oct;35(10):1958–65. Epub 2008 Aug 15.

60. Janse van Rensburg DC, Ker JA, Grant CC, Fletcher L. Effect of exercise on cardiac autonomic function in females with rheumatoid arthritis. Clin Rheumatol. 2012 Aug;31(8):1155–62. doi: 10.1007/s10067-012-1985-5. Epub 2012 Apr 19.