The degree of cardiac baroreflex involvement during active standing is associated with the quality of life in fibromyalgia patients

A.R. Zamunér, A. Porta, C.P. Andrade, M. Forti, A. Marchi, R. Furlan, F. Barbic, A.M. Catai, E. Silva

Research output: Contribution to journalArticlepeer-review


Fibromyalgia syndrome (FMS) is a rheumatologic disorder characterized by chronic widespread pain, fatigue and other symptoms. Baroreflex dysfunction has been observed in women with FMS. However, it is unknown whether the limited involvement of the baroreflex control during an orthostatic stimulus has some impact on the quality of life of the FMS patient. Therefore, the aim of the study is evaluate the relationship between the quality of life of the FMS patient and indexes of the cardiovascular autonomic control as estimated from spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP). We enrolled 35 women with FMS (age: 48.8±8.9 years; body mass index: 29.3±4.3 Kg/m2). The electrocardiogram, non-invasive finger blood pressure and respiratory activity were continuously recorded during 15 minutes at rest in supine position (REST) and in orthostatic position during active standing (STAND). Traditional cardiovascular autonomic control markers were assessed along with a Granger causality index assessing the strength of the causal relation from SAP to HP (CRSAP→HP) and measuring the degree of involvement of the cardiac baroreflex. The impact of FMS on quality of life was quantified by the fibromyalgia impact questionnaire (FIQ) and visual analog score for pain (VAS pain). No significant linear association was found between FIQ scores and the traditional cardiovascular indexes both at REST and during STAND (p>0.05). However, a negative relationship between CRSAP!HP during STAND and FIQ score was found (r = -0.56, p<0.01). Similar results were found with VAS pain. In conclusion, the lower the degree of cardiac baroreflex involvement during STAND in women with FMS, the higher the impact of FMS on the quality of life, thus suggesting that Granger causality analysis might be clinically helpful in assessing the state of the FMS patient. © 2017 Zamunér et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Original languageEnglish
JournalPLoS One
Issue number6
Publication statusPublished - 2017


  • adult
  • arterial pressure
  • Article
  • autonomic nervous system
  • blood pressure fluctuation
  • cardiovascular reflex
  • clinical article
  • controlled study
  • electrocardiography
  • female
  • fibromyalgia
  • Fibromyalgia Impact Questionnaire
  • heart cycle
  • human
  • middle aged
  • neuromodulation
  • non invasive procedure
  • pressoreceptor reflex
  • quality of life
  • standing
  • supine position
  • systolic blood pressure
  • visual analog scale
  • blood pressure
  • body mass
  • body position
  • heart
  • heart rate
  • pain measurement
  • pathophysiology
  • physiology
  • procedures
  • Adult
  • Autonomic Nervous System
  • Baroreflex
  • Blood Pressure
  • Body Mass Index
  • Electrocardiography
  • Female
  • Fibromyalgia
  • Heart
  • Heart Rate
  • Humans
  • Middle Aged
  • Pain Measurement
  • Posture
  • Quality of Life

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