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Naschitz JE, Rozenbaum M, Fields M, Isseroff H, Enis S, Babich JP, Peck S, Rubin Peck E, Gaitini L, Naschitz S, Sabo E, Rosner I.

Objectives. Aberrations of cardiovascular reactivity (CVR), an expression of autonomic function, lack specificity for a particular disorder. Recently, a CVR pattern particular to chronic fatigue syndrome has been observed. We aimed to develop methodologies for assessment of disease-specific CVR patterns.

Subjects. As a prototype, a population of 50 consecutive patients with Familial Mediterranean Fever (FMF) was studied compared with control populations.

Methods. A 10-minute supine-30 minute head-up tilt test with recording the heart rate and blood pressure or the pulse transit time was performed.

Five studies were conducted, applying different methods. In each study, statistical analysis identified independent predictors of the CVR in FMF. Based on regression coefficients of these predictors, a linear discriminant score (DS) was computed for every subject. Each study established an equation to assess the CVR, calculate the DS for FMF and determine the sensitivity and specificity of the DS cut-off. Results. In each of the five studies, abnormal CVR was observed in FMF patients. The best accuracy (88% sensitivity and 90.1% specificity for FMF) was obtained by a method based on beat-to-beat heart rate and pulse transit time recordings.

Data was processed by fractal and recurrence quantitative analysis with recordings in FMF patients compared with a mixed control population. Conclusions. Identification of disease-specific CVR patterns became possible with methodologies like those described in the present work. In FMF, disease-specific CVR may be explained by the interplay between neuro-endocrine loops specific to FMF with cardiovascular homeostatic mechanisms. Recognition of disease-specific CVR patterns may advance the understanding of homeostatic mechanisms and have implications in clinical practice.

PMID: 15330754 [PubMed - as supplied by publisher]