TY - JOUR

T1 - Autonomic response to walk tests is useful for assessing outcome measures in people with multiple sclerosis

AU - Kontaxis, Spyridon

AU - Laporta, Estela

AU - Garcia, Esther

AU - Guerrero, Ana Isabel

AU - Zabalza, Ana

AU - Matteo, Martinis

AU - Lucia, Roselli

AU - Simblett, Sara

AU - Weyer, Janice

AU - Hotopf, Matthew

AU - Narayan, Vaibhav A.

AU - Rashid, Zulqarnain

AU - Folarin, Amos A.

AU - Dobson, Richard J.B.

AU - Buron, Mathias Due

AU - Leocani, Letizia

AU - Cummins, Nicholas

AU - Vairavan, Srinivasan

AU - Costa, Gloria Dalla

AU - Magyari, Melinda

AU - Sørensen, Per Soelberg

AU - Nos, Carlos

AU - Bailón, Raquel

AU - Comi, Giancarlo

AU - the RADAR-CNS Consortium

N1 - Publisher Copyright: Copyright © 2023 Kontaxis, Laporta, Garcia, Guerrero, Zabalza, Matteo, Lucia, Simblett, Weyer, Hotopf, Narayan, Rashid, Folarin, Dobson, Buron, Leocani, Cummins, Vairavan, Costa, Magyari, Sørensen, Nos, Bailón, Comi and the RADAR-CNS Consortium.

PY - 2023

Y1 - 2023

N2 - Objective: The aim of this study was to evaluate the association between changes in the autonomic control of cardiorespiratory system induced by walk tests and outcome measures in people with Multiple Sclerosis (pwMS). Methods: Electrocardiogram (ECG) recordings of 148 people with Relapsing-Remitting MS (RRMS) and 58 with Secondary Progressive MS (SPMS) were acquired using a wearable device before, during, and after walk test performance from a total of 386 periodical clinical visits. A subset of 90 participants repeated a walk test at home. Various MS-related symptoms, including fatigue, disability, and walking capacity were evaluated at each clinical visit, while heart rate variability (HRV) and ECG-derived respiration (EDR) were analyzed to assess autonomic nervous system (ANS) function. Statistical tests were conducted to assess differences in ANS control between pwMS grouped based on the phenotype or the severity of MS-related symptoms. Furthermore, correlation coefficients (r) were calculated to assess the association between the most significant ANS parameters and MS-outcome measures. Results: People with SPMS, compared to RRMS, reached higher mean heart rate (HRM) values during walk test, and larger sympathovagal balance after test performance. Furthermore, pwMS who were able to adjust their HRM and ventilatory values, such as respiratory rate and standard deviation of the ECG-derived respiration, were associated with better clinical outcomes. Correlation analyses showed weak associations between ANS parameters and clinical outcomes when the Multiple Sclerosis phenotype is not taken into account. Blunted autonomic response, in particular HRM reactivity, was related with worse walking capacity, yielding r = 0.36 r = 0.29 (RRMS) and r > 0.5 (SPMS). A positive strong correlation r > 0.7 r > 0.65 between cardiorespiratory parameters derived at hospital and at home was also found. Conclusion: Autonomic function, as measured by HRV, differs according to MS phenotype. Autonomic response to walk tests may be useful for assessing clinical outcomes, mainly in the progressive stage of MS. Participants with larger changes in HRM are able to walk longer distance, while reduced ventilatory function during and after walk test performance is associated with higher fatigue and disability severity scores. Monitoring of disorder severity could also be feasible using ECG-derived cardiac and respiratory parameters recorded with a wearable device at home.

AB - Objective: The aim of this study was to evaluate the association between changes in the autonomic control of cardiorespiratory system induced by walk tests and outcome measures in people with Multiple Sclerosis (pwMS). Methods: Electrocardiogram (ECG) recordings of 148 people with Relapsing-Remitting MS (RRMS) and 58 with Secondary Progressive MS (SPMS) were acquired using a wearable device before, during, and after walk test performance from a total of 386 periodical clinical visits. A subset of 90 participants repeated a walk test at home. Various MS-related symptoms, including fatigue, disability, and walking capacity were evaluated at each clinical visit, while heart rate variability (HRV) and ECG-derived respiration (EDR) were analyzed to assess autonomic nervous system (ANS) function. Statistical tests were conducted to assess differences in ANS control between pwMS grouped based on the phenotype or the severity of MS-related symptoms. Furthermore, correlation coefficients (r) were calculated to assess the association between the most significant ANS parameters and MS-outcome measures. Results: People with SPMS, compared to RRMS, reached higher mean heart rate (HRM) values during walk test, and larger sympathovagal balance after test performance. Furthermore, pwMS who were able to adjust their HRM and ventilatory values, such as respiratory rate and standard deviation of the ECG-derived respiration, were associated with better clinical outcomes. Correlation analyses showed weak associations between ANS parameters and clinical outcomes when the Multiple Sclerosis phenotype is not taken into account. Blunted autonomic response, in particular HRM reactivity, was related with worse walking capacity, yielding r = 0.36 r = 0.29 (RRMS) and r > 0.5 (SPMS). A positive strong correlation r > 0.7 r > 0.65 between cardiorespiratory parameters derived at hospital and at home was also found. Conclusion: Autonomic function, as measured by HRV, differs according to MS phenotype. Autonomic response to walk tests may be useful for assessing clinical outcomes, mainly in the progressive stage of MS. Participants with larger changes in HRM are able to walk longer distance, while reduced ventilatory function during and after walk test performance is associated with higher fatigue and disability severity scores. Monitoring of disorder severity could also be feasible using ECG-derived cardiac and respiratory parameters recorded with a wearable device at home.

KW - autonomic nervous system

KW - disability

KW - ECG-derived respiration

KW - fatigue

KW - heart rate variability

KW - relapsing-remitting multiple sclerosis

KW - secondary progressive multiple sclerosis

KW - walking capacity

UR - http://www.scopus.com/inward/record.url?scp=85153848974&partnerID=8YFLogxK

U2 - 10.3389/fphys.2023.1145818

DO - 10.3389/fphys.2023.1145818

M3 - Journal article

C2 - 37089424

AN - SCOPUS:85153848974

VL - 14

JO - Frontiers in Physiology

JF - Frontiers in Physiology

SN - 1664-042X

M1 - 1145818

ER -