Analysis of Heart-Rate Variability during Angioedema Attacks in Patients with Hereditary C1-Inhibitor Deficiency

Francesca Perego, Beatrice De Maria, Maria Bova, Angelica Petraroli, Azzurra Marcelli Cesoni, Valeria De Grazia, Lorenza Chiara Zingale, Alberto Porta, Giuseppe Spadaro and Laura Adelaide Dalla Vecchia
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Francesca Perego: Department of Medicine, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy
Beatrice De Maria: Bioengineering Laboratory, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy
Maria Bova: Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples “Federico II”, 80138 Naples, Italy
Angelica Petraroli: Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples “Federico II”, 80138 Naples, Italy
Azzurra Marcelli Cesoni: Department of Medicine, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy
Valeria De Grazia: Department of Medicine, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy
Lorenza Chiara Zingale: Department of Medicine, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy
Alberto Porta: Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
Giuseppe Spadaro: Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples “Federico II”, 80138 Naples, Italy
Laura Adelaide Dalla Vecchia: Department of Medicine, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy

IJERPH, 2021, vol. 18, issue 6, 1-9

Abstract: C1-inhibitor hereditary angioedema (C1-INH-HAE) is a rare disease characterized by self-limiting edema associated with localized vasodilation due to increased levels of circulating bradykinin. C1-INH-HAE directly influences patients’ everyday lives, as attacks are unpredictable in frequency, severity, and the involved anatomical site. The autonomic nervous system could be involved in remission. The cardiac autonomic profile has not yet been evaluated during the attack or prodromal phases. In this study, a multiday continuous electrocardiogram was obtained in four C1-INH-HAE patients until attack occurrence. Power spectral heart rate variability (HRV) indices were computed over the 4 h preceding the attack and during the first 4 h of the attack in three patients. Increased vagal modulation of the sinus node was detected in the prodromal phase. This finding may reflect localized vasodilation mediated by the release of bradykinin. HRV analysis may furnish early markers of an impending angioedema attack, thereby helping to identify patients at higher risk of attack recurrence. In this perspective, it could assist in the timing, titration, and optimization of prophylactic therapy, and thus improve patients’ quality of life.

Keywords: C1-inhibitor hereditary angioedema; heart rate variability; cardiac neural control; autonomic nervous system; spectral analysis; multiday ECG monitoring; quality of life; burden of disease (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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