The evaluation of heart rate recovery in rheumatoid arthritis patients

In rheumatoid arthritis, cardiac complications can be seen both due to the disease and secondary to medical therapies and they are mostly asymptomatic (53). All of the structures in the heart such as, cardiac valves, conductory system, myocardium, endocardium, pericardium can be affected in rheumatoid arthritis (2). Therefore it is important to evaluate the cardiovascular risk and predicting the risk of sudden cardiac death. Heart rate recovery (HRR) is a simple test used to determine the cardiac autonomic activity in patients with cardiovascular disease and healthy subjects. It is a reliable index to determine mortality and there are many different studies about this subject recently. We aimed to compare the heart rate recovery indices between patients with rheumatoid arthritis and control subjects. According to our findings there was a reduction in rheumatoid arthritis patients without active joint disease or frank cardiac involvement compared to control subjects in heart rate from the rate at peak exercise to the rate at the 1st (HRR1) minute after the cessation of exercise stress testing, thus this finding shows cardiac autonomic dysfunction, especially vagus dysfunction in HRR1. In our study, there was a notable decrease in HRR in patients compared to control subjects and the sudden decrease between HRR1 and HRR5 was statistically significant. The significant sudden decrease between HRR1 and HRR5 shows that there is a dysfunction in not only in vagus but also in sympathetic system. Considering, the sympathetic system is more effective between HRR1 and HRR5, there should be more studies about dysfunction of sympathetic system in rheumatoid arthritis. Our findings will contribute to further studies in this area. Keywords; Rheumatoid arthritis, Heart rate recovery, Cardiac autonomic activity, vagus dysfunction, sympathetic system dysfunction