Alterations in short-term blood pressure variability related to disease severity and autonomic symptoms in myasthenia gravis patients

Monika Zawadka-Kunikowska; Łukasz Rzepiński; Mirosława Cieślicka; Jacek J Klawe; Małgorzata Tafil-Klawe

doi:10.1007/s10072-023-06927-1

Alterations in short-term blood pressure variability related to disease severity and autonomic symptoms in myasthenia gravis patients

Neurol Sci. 2023 Nov;44(11):4065-4075. doi: 10.1007/s10072-023-06927-1. Epub 2023 Jun 28.

Authors

Monika Zawadka-Kunikowska¹, Łukasz Rzepiński^{2

3}, Mirosława Cieślicka⁴, Jacek J Klawe⁵, Małgorzata Tafil-Klawe⁴

Affiliations

¹ Department of Human Physiology, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Karłowicza 24, 85-092, Bydgoszcz, Poland. m.zkunikowska@cm.umk.pl.
² Sanitas-Neurology Outpatient Clinic, Dworcowa 110, 85-010, Bydgoszcz, Poland.
³ Department of Neurology, 10th Military Research Hospital and Polyclinic, 85-681, Bydgoszcz, Poland.
⁴ Department of Human Physiology, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Karłowicza 24, 85-092, Bydgoszcz, Poland.
⁵ Department of Hygiene, Epidemiology, Ergonomy and Postgraduate Education, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, M. Sklodowskiej-Curie 9, 85-094, Bydgoszcz, Poland.

Abstract

Objectives: We aimed to evaluate beat-to-beat blood pressure variability (BPV) during head-up tilt test (HUTT) in patients with mild and moderate myasthenia gravis (MG) compared to healthy controls (HCs), and its association with the severity of autonomic symptoms.

Methods: A total of 50 MG patients and 30 HCs were evaluated. Patients were stratified into 2 groups regarding Myasthenia Gravis Foundation of America (MGFA) classification: mild (I,II MGFA), moderate form (III MGFA). Autonomic symptoms were assessed by COMPASS-31 questionnaire. Cardiovascular parameters, indices of very short-term systolic (SBPV), and diastolic blood pressure (BP) variability (DBPV) were assessed at rest, and during HUTT.

Results: Moderate MG patients were characterized by an overall shift of sympathovagal balance toward sympathetic predominance, either at rest and during HUTT, as well as lower values of high frequency (HFnu) of DBPV during HUTT, compared to HCs and mild MG. Similarly, moderate MG showed higher resting low frequency (LFnu) of DBPV (p=0.035), higher COMPASS-31 score (p=0.031), and orthostatic intolerance sub-score (p=0.019) than mild MG patients. Compared to HCs, mild MG patients showed lower Δmean BP (p=0.029), Δdiastolic BP (p=0.016). Autonomic symptoms were associated with lower BP values, at rest and during HUTT, and lower LF BPV parameters during HUTT.

Conclusion: MG patients present significant alterations in BPV, both at rest and in response to orthostatic stress, which are related to autonomic symptoms and disease severity. This study confirms the importance of monitoring BPV when evaluating cardiovascular autonomic function and its evolution over the course of MG disease.

Keywords: Autonomic dysfunction; Blood pressure variability; COMPASS-31 scale; Myasthenia gravis; Orthostatic intolerance; Postural tachycardia syndrome.