Heart rate variability in patients with lymphoproliferative diseases in remission

Abstract

Aim: to evaluate the heart rate variability in patients with regression of different lymphoproliferative diseases, to assess the heart rate variability depending on appearance of cardiovascular events during 3 years after reaching regression of chronic lymphocytic leukemia. Methods: 376 patients with full or partial remission of lymphoproliferative diseases (156 patients with chronic lymphocytic leukemia (CLL), 82 patients with non-Hodgkin lymphoma (NHL), 35 patients with Hodgkin lymphoma (HL), 89 patients with multiple myeloma(MM)) were enrolled in the study. All patients and control subjects underwent 24-hour Holter monitoring (“Cardiosence”,Ukraine), with continuous time-dependent and spectral analysis of heart rate variability. Results: SDNN as at day (P < 0.0001, P < 0.0001, P = 0.0005) as at night (P < 0.0001, P < 0.0001, P < 0.0001) was significantly lower in patients with CLL, NHL, MM than in controls, and RMSDD findings were similar for CLL and MM at day (P = 0.016, р=0.032) and at night (P = 0.002, P = 0.011). The LF values of all groups of patients were significantly lower than those of controls, and HF values of patients with CLL (P = 0.043) and HNL (P = 0.04) were lower. 397 cumulative clinical events occurred in 45 patients with CLL (51.9 %) within the follow-up, with their distribution being as follows: 11 deaths, 218 cardiac arrhythmias, 33 cardiac ischemic events, 9 strokes, 64 chronic heart failures and 62 hospital admissions for cardiovascular reasons. There were 29 non-cardiovascular deaths. There were some differences in the heart rate variability values in the group with cardiovascular events at follow-up visit as with values at baseline (SDNNd (58.90 ± 90.23 мс та 22.01 ± 15.15 мс; P < 0.001), LFd (193.33 ± 120.24 мс2 та 111.99 ± 95.05 мс2; P = 0.003), LFn (240.14 ± 117.52 мс2 та 178.53 ± 173.27 мс2; P = 0.035), HFd (132.75 ± 110.06 мс2 та 85.69 ± 42.31 мс2; P = 0.031), HFn (224.61 ± 123.02 мс2 та 104.38 ± 79.38 мс2; P < 0.001)) as with values of the group without cardiovascular events at follow-up (SDNNd (22.01 ± 15.15 мс та 40.19 ± 69.11 мс; P = 0.038), SDNNn (30.36 ± 28.21 мс та 55.71 ± 79.64 мс; P = 0.02), LFd (111.99 ± 95.05 мс2 та 196.08 ± 157.05 мс2; P = 0.002), LFn (178.53 ± 173.27 мс2 та 266.18 ± 176.40 мс2; P = 0.036), LFd/HFd (1.57 ± 1.48 та 2.40 ± 2.00; P =0.024)). In Cox regression models, the most powerful predictors of cardiovascular events in patients with lymphoproliferative disorders were SDNNd, LFn, HFn, and LFd/HFn. Conclusion: Heart rate variability changes in patients with regression of lymphoproliferative diseases, which may be due to depression of sympathetic activity and activation of parasympathic activity. In patients with regression of chronic lymphocytic leukemia continuous time-dependent and spectral analysis of heart rate variability may provide additional value in the risk of cardiovascular events.

Keywords

• heart rate variability
• lymphoproliferative diseases
• prognosis