Increased Sympathetic Cardiac Autonomic Modulation after Two Consecutive Tilt Tests in Women with Polycystic Ovary Syndrome

Ribeiro, Victor Barbosa; Kogure, Gislaine Satyko; Silva, Rafael Costa; Souza, Hugo Celso Dutra; Ferriani, Rui Alberto; Reis, Rosana Maria dos

doi:10.1055/s-0040-1701467

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Articles, Gynecological Endocrinology • Rev. Bras. Ginecol. Obstet. 42 (2) • Feb 2020 • https://doi.org/10.1055/s-0040-1701467 copy

Increased Sympathetic Cardiac Autonomic Modulation after Two Consecutive Tilt Tests in Women with Polycystic Ovary Syndrome

Aumento da modulação autonômica cardíaca simpática após dois testes de inclinação consecutivos em mulheres com síndrome dos ovários policísticos

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The present study aimed to analyze cardiac autonomic modulation via spectral and symbolic analysis of heart rate variability (HRV) in women with polycystic ovary syndrome (PCOS) who were subjected to two consecutive tilt tests.

Methods

A total of 64 women were selected and divided into 2 groups: control (without PCOS), and PCOS. Concentrations of follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, homocysteine, sex hormone-binding globulin, thyroid stimulating hormone, fasting insulin, testosterone, androstenedione, and 17-hydroxyprogesterone levels, triglycerides, free androgen index (FAI), and homeostasis assessment model (HOMA-IR) were assessed. Cardiac autonomic modulation was evaluated by spectral and symbolic analyses during two consecutive tilt tests (two moments) and supine moments before, between and after (three moments) the tilt tests.

Results

Women with PCOS had higher fasting insulin, HOMA-IR indexes, testosterone and FAI. Additionally, we observed that the PCOS group had greater sympathetic autonomic cardiac modulation in supine 2, tilt 1, and supine 3 moments compared with controls.

Conclusion

Women with PCOS had higher autonomic sympathetic cardiac modulation even after a second tilt test. No adaptation to this provocative test was observed. Spectral analysis was more sensitive for identifying differences between groups than the symbolic analysis.

Keywords
polycystic ovary syndrome; cardiac autonomic modulation; hyperandrogenism; spectral analysis; symbolic analysis

Comparison	CG (n = 32)	PCOS (n = 32)
Anthropometry parameters
Age, years	29.4 (0.90)	27.0 (0.93)
Weight, Kg	69 (2.57)	75 (3.04)
Height, m	1.61 (0.01)	1.62 (0.01)
BMI	26.8 (1.02)	28.8 (1.15)
WC, cm	78 (2.00)	89 (2.45)
HC, cm	105 (1.91)	108 (1.94)
WHR	0.74 (0.01)	0.76 (0.01)
Body Fat, %	38.8 (1.23)	40.5 (0.92)
Biochemical parameters
Total Cholesterol, mg/dL	195 (8.99)	198 (6.36)
Triglycerides, mg/dL	95 (6.86)	128 (12.87)
LDL, mg/dL	123 (7.36)	119 (5.29)
HDL, mg/dL	52 (2.10)	54 (2.04)
Fasting Insulin, mg/dL	5.88 (0.95)	9.34 (1.16)^* * p < 0.05.
Fasting Glycemia, mg/dL	97 (3.22)	100 (3.45)
Homa-IR	1.42 (0.26)	2.36 (0.33)^* * p < 0.05.
Homocysteine, µmol/L	7.37 (0.25)	7.86 (0.40)
TSH, uIU/mL	2.01 (0.98)	2.48 (1.27)
PRL, ng/ml	13.9 (6.58)	16.1 (16.1)
17-OHP, ng/dL	105 (63)	113 (62)
FSH, uIU/mL	4.26 (0.43)	4.72 (0.50)
LH, uUI/mL	5.58 (1.19)	6.96 (1.21)
Testosterone, ng/dL	66 (4.67)	86 (6.68)^* * p < 0.05.
Androstenedione, ng/dL	102 (5.98)	112 (8.72)
SHBG, nmol/L	65 (6.52)	56 (7.64)
FAI	4.65 (0.54)	7.90 (0.91)^* * p < 0.05.

	Supine 1		Supine 2		Supine 3
	CG	PCOS	CG	PCOS	CG	PCOS
Spectral Analysis
RMSSD, ms	55 (6.3)	54 (5.2)	72 (7.1)	69 (6.7)	70 (6.2)	75(7.5)
iRR, ms	896 (20)	901 (15)	967 (21)	972 (16)	978 (23)	978(17)
LF, ms²	728 (145)	883 (113)	910 (152)	1220 (162)	1053 (189)	1582 (193)^B
HF, ms²	1520 (433)	1378 (250)	2385 (570)	2073 (404)	2046 (384)	2367 (478)
LF, n.u.	38 (2.5)	44 (2.7)	35 (2.8)	43 (3.0)^A	37 (2.4)	47 (3.2)^B
HF, n.u.	62 (2,5)	56 (2.7)	65 (2.8)	57 (3.0)^A	63 (2.4)	53 (3.2)^B
LF/HF ratio	0.70 (0.08)	0.95 (0.12)	0.69 (0.13)	1.02 (0.19)^A	0.69 (0.09)	1.34 (0.31)^B
Variance, ms²	2942 (633)	3279 (405)	4181 (750)	4428 (626)	4139 (629)	5643 (753)
Symbolic Analysis
0 V, %	9.7 (1.3)	11 (1.39)	7.8 (1.0)	10 (2.41)	8.7 (1.2)	12 (1.69)
1 V, %	40 (1.2)	44 (0.9)	37 (1.1)	39 (1.1)	38 (1.1)	39 (1.0)
2 LV, %	20 (1.1)	17 (1.0)	20 (1.4)	17 (1.1)	18 (1.2)	17 (1.0)
2 UV, %	36 (2.3)	27 (1.6)	36 (2.2)	33 (1.9)	30 (2.3)	32 (2.0)
2 V Total, %	50 (2.2)	45 (2.0)	54 (2.0)	51 (2.2)	54 (2.0)	49 (2.4)
0V/2V ratio	0.26 (0.06)	0.35 (0.08)	0.18 (0.05)	0.28 (0.07)	0.21 (0.05)	0.34 (0.06)

	Tilt 1		Tilt 2
	CG	PCOS	CG	PCOS
Spectral Analysis
RMSSD, ms	24 (3.0)	21 (1.6)	25 (3.6)	21 (1.7)
iRR, ms	720 (17)	711 (12)	712 (17)	708 (13)
LF, ms²	595 (115)	759 (82)^A	860 (130)	863 (140)
HF, ms²	367 (107)	251 (42)	422 (150)	237 (43)
LF, n.u.	66 (2.7)	76 (2.2)^A	73 (2.5)	78 (2.3)
HF, n.u.	34 (2.7)	24 (2.2)^A	27 (2.5)	22 (2.3)
LF/HF ratio	2.54 (0.30)	4.88 (0.73)^A	3.98 (0.49)	5.44 (0.69)
Variance, ms²	1579 (246)	1896 (172)^A	2217 (367)	2206 (231)
Symbolic Analysis
0 V, %	29 (2.4)	34 (2.10)	33 (2.3)	38 (2.05)
1 V, %	45 (0.9)	46 (0.8)	45 (0.8)	44 (0.6)
2 LV, %	13 (1.0)	10 (0.9)	11 (0.9)	9.2 (0.9)
2 UV, %	9.9 (1.3)	9.6 (0.9)	12 (1.4)	8.6 (0.9)
2 V Total, %	25 (2.2)	20 (1.6)	21 (2.0)	18 (1.6)
0V/2V ratio	2.39 (0.68)	2.74 (0.52)	2.70 (0.50)	3.13 (0.46)

	CG (n = 32)
	Supine 1	Tilt 1	Supine 2	Tilt 2	Supine 3
Spectral Analysis
RMSSD, ms	55 (6.3)	24 (3.0)^J	72 (7.1)^HI	25 (3.6)^EG	70 (6.2)^ACD
iRR, ms	896 (20)	720 (17)^J	967 (21)^HI	712 (17)^EG	978 (23)^ACD
LF, ms²	728 (145)	595 (115)	910 (152)	860 (130)	1053 (189)
HF, ms²	1520 (433)	367 (107)^J	2385 (570)^HI	422 (150)^EG	2046 (384)^ACD
LF, n.u.	38 (2.5)	66 (2.7)^J	35 (2.8)^H	73 (2.5)^EFG	37 (2.4)^AC
HF, n.u.	62 (2.5)	34 (2.7)^J	65 (2.8)^H	27 (2.5)^EFG	63 (2.4)^AC
LF/HF ratio	0.70 (0.08)	2.54 (0.30)^J	0.69 (0.13)^H	3.98 (0.49)^EFG	0.69 (0.09)^AC
Variance, ms²	2942 (633)	1579 (246)^J	4181 (750)^HI	2217 (367)^EF	4139 (629)^ACD
Symbolic Analysis
0 V, %	9.7 (1.3)	29 (2.4)^J	7.8 (1.0)^H	33 (2.3)^EFG	8.7 (1.2)^AC
1 V, %	40 (1.2)	45 (0.9)^J	37 (1.1)^HI	45 (0.8)^EG	38 (1.1)^ACD
2 LV, %	20 (1.1)	13 (1.0)^J	20 (1.4)^H	11 (0.9)^EG	18 (1.2)^AC
2 UV, %	36 (2.3)	9.9 (1.3)^J	36 (2.2)^H	12 (1.4)^EFG	30 (2.3)^ABCD
2 V Total, %	50 (2.2)	25 (2.2)^J	54 (2.0)^H	21 (2.0)^EFG	54 (2.0)^AC
0V/2V ratio	0.26 (0.06)	2.39 (0.68)^J	0.18 (0.05)^H	2.70 (0.50)^EFG	0.21 (0.05)^AC

	PCOS (n = 32)
	Supine 1	Tilt 1	Supine 2	Tilt 2	Supine 3
Spectral Analysis
RMSSD, ms	54 (5.2)	21 (1.6)^J	69 (6.7)^HI	21 (1.7)^EG	75 (7.5)^ACD
iRR, ms	901 (15)	711 (12)^J	972 (16)^HI	708 (13)^EG	978 (17)^ACD
LF, ms²	883 (113)	759 (82)	1220 (162)^HI	863 (140)^E	1582 (193)^ABCD
HF, ms²	1378 (250)	251 (42)^J	2073 (404)^HI	237 (43)^EG	2367 (478)^ACD
LF, n.u.	44 (2.7)	76 (2.2)^J	43 (3.0)^H	78 (2.3)^EG	47 (3.2)^AC
HF, n.u.	56 (2.7)	24 (2.2)^J	57 (3.0)^H	22 (2.3)^EG	53 (3.2)^AC
LF/HF ratio	0.95 (0.12)	4.88 (0.73)^J	1.02 (0.19)^H	5.44 (0.69)^EG	1.34 (0.31)^AC
Variance, ms²	3279 (405)	1896 (172)^J	4428 (626)^HI	2206 (231)^EFG	5643 (753)^ABCD
Symbolic Analysis
0 V, %	11 (1.39)	34 (2.10)^J	10 (2.41)^HI	38 (2.05)^EFG	12 (1.69)^ACD
1 V, %	44 (0.9)	46 (0.8)	39 (1.1)^HI	44 (0.6)^E	39 (1.0)^ACD
2 LV, %	17 (1.0)	10 (0.9)^J	17 (1.1)^H	9.2 (0.9)^EFG	17 (1.0)^AC
2 UV, %	27 (1.6)	9.6 (0.9)^J	33 (1.9)^HI	8.6 (0.9)^EFG	32 (2.0)^ACD
2 V Total, %	45 (2.0)	20 (1.6)^J	51 (2.2)^HI	18 (1.6)^EFG	49 (2.4)^ACD
0V/2V ratio	0.35 (0.08)	2.74 (0.52)^J	0.28 (0.07)^H	3.13 (0.46)^EFG	0.34(0.06)^AC

Position	CG		PCOS		Metabolic Syndrome (MS)
	Without MS n = (26) n (%)	MS n = (6) n (%)	Without MS n = (24) n (%)	MS n = (8) n (%)	CG n = (6) n (%)	PCOS n = (8) n (%)
Supine 1	0.64 (0.07)	0.97 (0.33)	0.86 (0.10)	1.25 (0.38)	0.97 (0.33)	1.25 (0.38)
Tilt 1	2.64 (0.32)	2.10 (0.80)	5.51 (1.89)	3.00 (0.94)	2.10 (0.80)	3.00 (0.94)
Supine 2	0.56 (0.07)	1.27 (0.61)	0.75 (0.09)	1.81 (0.68)	1.27 (0.61)	1.81 (0.68)
Tilt 2	3.80 (0.50)	4.74 (1.53)	5.99 (0.81)	3.75 (1.20)	4.74 (1.53)	3.75 (1.20)
Supine 3	0.59 (0.06)	1.12 (0.61)	0.96 (0.13)	2.49 (1.14)	1.12 (0.61)	2.49 (1.14)

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[1] Address for correspondence Victor Barbosa Ribeiro, PhD, Department of Gynecology and Obstetrics, Medical School of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP 14049-900, Brazil (e-mail: victorbarbosa@ifsp.edu.br).