Abnormalities of cardiovascular neural control and reduced orthostatic tolerance in patients with primary fibromyalgia

Raffaello Furlan, Simona Colombo, Francesca Perego, Fabiola Atzeni, Alessandro Diana, Franca Barbic, Alberto Porta, Fabio Pace, Alberto Malliani, Piercarlo Sarzi-Puttini

Research output: Contribution to journalArticle

Abstract

Objective. Fibromyalgia (FM) is a syndrome characterized by widespread musculoskeletal pain. Symptoms of orthostatic intolerance may also be present, suggesting underlying abnormalities of cardiovascular neural regulation. We tested the hypothesis that FM is characterized by sympathetic overactivity and alterations in cardiovascular autonomic response to gravitational stimulus. Methods. Sixteen patients with primary FM and 16 healthy controls underwent electrocardiography examination, finger blood pressure, respiration, and muscle sympathetic nerve activity (MSNA) recordings at rest and during stepwise tilt test, up to 75°. The autonomic profile was assessed by MSNA, plasma catecholamine, and spectral indices of cardiac sympathetic (LFRR in normalized units, NU) and vagal (HFRR both in absolute and NU) modulation and of sympathetic vasomotor control (LFSAP) computed by spectrum analysis of RR and systolic arterial pressure (SAP) variability. Arterial baroreflex function was evaluated by the SAP/RR spontaneous-sequences technique, the index a, and the gain of MSNA/diastolic pressure relationship during stepwise tilt test. Results. At rest, patients showed higher values of heart rate, MSNA, LFRR NU, LF/HF, LFSAP, and reduced HFRR than controls. During tilt test, lack of increase of MSNA, less decrease of HFRR, and excessive rate (44%) of syncope were found in patients, suggesting reduced capability to enhance the sympathetic activity to vessels and withdraw the vagal modulation to sino-atrial node. Baroreflex function was similar in both groups. Conclusion. Patients with FM have an overall enhancement of cardiovascular sympathetic activity while recumbent. Lack of increased sympathetic discharge to vessels and decreased cardiac vagal activity characterize their autonomic profile during tilt test, and might account for the excessive rate of syncope.

Original languageEnglish
Pages (from-to)1787-1793
Number of pages7
JournalJournal of Rheumatology
Volume32
Issue number9
Publication statusPublished - Sep 2005

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Keywords

  • Baroreceptors
  • Fibromyalgia
  • Sympathetic nervous system
  • Syncope
  • Tilt test

ASJC Scopus subject areas

  • Rheumatology
  • Immunology

Cite this

Furlan, R., Colombo, S., Perego, F., Atzeni, F., Diana, A., Barbic, F., Porta, A., Pace, F., Malliani, A., & Sarzi-Puttini, P. (2005). Abnormalities of cardiovascular neural control and reduced orthostatic tolerance in patients with primary fibromyalgia. Journal of Rheumatology, 32(9), 1787-1793.