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Heart rate variability predicts the magnitude of heart rate decrease after fingolimod initiation

Multiple Sclerosis and Related Disorders, Volume 10, November 2016, Pages 86-89

Abstract

Background

Fingolimod is an immunomodulator with a disease modifying effect on relapsing-remitting multiple sclerosis (RRMS). A heart rate (HR) decrease shortly after fingolimod initiation, however, requires a clinical vigilance. The aim of this study was to prospectively investigate whether cardiac autonomic regulation can predict the magnitude of HR decrease after fingolimod initiation.

Methods

Twenty-five patients with RRMS underwent ambulatory 24-h electrocardiogram recording to assess HR variability 20±16 days before fingolimod initiation (baseline) and repeated at the day of fingolimod initiation to assess the magnitude of HR decrease. The percentage of normal RR-intervals with duration more than 50 ms different from the previous normal RR-interval (pNN50) was calculated (among the other HR variability parameters) to assess cardiac autonomic regulation. The maximal HR decrease (ΔHR) after the first dose of fingolimod was assessed in absolute units (beats/min) and in percentage (%).

Results

The maximal ΔHR was −20±11 beats/min (−23±12%) on the average. pNN50 calculated at baseline correlated with ΔHR% (r=−0.657, p<0.001). A HR decrease ≥20% was found in 10/14 patients with pNN50≥10%. The positive and negative predictive values of pNN50≥10% to predict ΔHR≥20% were 83% and 69%, respectively leading to accuracy of 76%.

Conclusions

Cardiac autonomic regulation (pNN50>10%) at baseline can be used to predict the magnitude of HR decrease after the first dose of fingolimod.

Trial registration

ClinicalTrials.gov (NCT01704183).

Highlights

  • Fingolimod has disease modifying effect on relapsing-remitting multiple sclerosis.
  • Heart rate decrease after fingolimod initiation requires a clinical vigilance.
  • Predefined status of autonomic regulation predicts magnitude of heart rate decrease.
  • Patients at risk for greater heart rate decrease can be identified.

Keywords: Fingolimod, Heart rate, Heart rate variability, Multiple sclerosis.

Footnotes

a Department of Neurology, Mikkeli Central Hospital, Mikkeli, Finland

b Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland

c Neuro Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland

d Heart Center Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland

Corresponding author.