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

Spyridon Kontaxis; Estela Laporta; Esther Garcia; Ana Isabel Guerrero; Ana Zabalza; Martinis Matteo; Roselli Lucia; Sara Simblett; Janice Weyer; Matthew Hotopf; Vaibhav A Narayan; Zulqarnain Rashid; Amos A Folarin; Richard J B Dobson; Mathias Due Buron; Letizia Leocani; Nicholas Cummins; Srinivasan Vairavan; Gloria Dalla Costa; Melinda Magyari; Per Soelberg Sørensen; Carlos Nos; Raquel Bailón; Giancarlo Comi; null The Radar-Cns Consortium

doi:10.3389/fphys.2023.1145818

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

Spyridon Kontaxis, Estela Laporta, Esther Garcia, Ana Isabel Guerrero, Ana Zabalza, Martinis Matteo, Roselli Lucia, Sara Simblett, Janice Weyer, Matthew Hotopf, Vaibhav A Narayan, Zulqarnain Rashid, Amos A Folarin, Richard J B Dobson, Mathias Due Buron, Letizia Leocani, Nicholas Cummins, Srinivasan Vairavan, Gloria Dalla Costa, Melinda MagyariPer Soelberg Sørensen, Carlos Nos, Raquel Bailón, Giancarlo Comi, The Radar-Cns Consortium

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Abstract

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.

Original language	English
Article number	1145818
Pages (from-to)	1145818
Journal	Frontiers in Physiology
Volume	14
DOIs	https://doi.org/10.3389/fphys.2023.1145818
Publication status	Published - 2023

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10.3389/fphys.2023.1145818

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Kontaxis, S., Laporta, E., Garcia, E., Guerrero, A. I., Zabalza, A., Matteo, M., Lucia, R., Simblett, S., Weyer, J., Hotopf, M., Narayan, V. A., Rashid, Z., Folarin, A. A., Dobson, R. J. B., Buron, M. D., Leocani, L., Cummins, N., Vairavan, S., Costa, G. D., ... The Radar-Cns Consortium (2023). Autonomic response to walk tests is useful for assessing outcome measures in people with multiple sclerosis. Frontiers in Physiology, 14, 1145818. Article 1145818. https://doi.org/10.3389/fphys.2023.1145818

@article{e60db6a48fb949e3b40b0fd6278a0808,

title = "Autonomic response to walk tests is useful for assessing outcome measures in people with multiple sclerosis",

abstract = " 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. ",

author = "Spyridon Kontaxis and Estela Laporta and Esther Garcia and Guerrero, {Ana Isabel} and Ana Zabalza and Martinis Matteo and Roselli Lucia and Sara Simblett and Janice Weyer and Matthew Hotopf and Narayan, {Vaibhav A} and Zulqarnain Rashid and Folarin, {Amos A} and Dobson, {Richard J B} and Buron, {Mathias Due} and Letizia Leocani and Nicholas Cummins and Srinivasan Vairavan and Costa, {Gloria Dalla} and Melinda Magyari and S{\o}rensen, {Per Soelberg} and Carlos Nos and Raquel Bail{\'o}n and Giancarlo Comi and {The Radar-Cns Consortium}",

note = "Copyright {\textcopyright} 2023 Kontaxis, Laporta, Garcia, Guerrero, Zabalza, Matteo, Lucia, Simblett, Weyer, Hotopf, Narayan, Rashid, Folarin, Dobson, Buron, Leocani, Cummins, Vairavan, Costa, Magyari, S{\o}rensen, Nos, Bail{\'o}n, Comi and the RADAR-CNS Consortium. Funding Information: The RADAR-CNS project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115902. This Joint Undertaking receives support from the European Union{\textquoteright}s Horizon 2020 research and innovation programme and EFPIA (www.imi.europa.eu). This communication reflects the views of the RADAR-CNS Consortium and neither IMI nor the European Union and EFPIA are liable for any use that may be made of the information contained herein. Morover, the work was supported by the Grant TED2021-131106B-I00 funded by MCIN/AEI/ 10.13039/501100011033 and by the “European Union NextGenerationEU/PRTR”. Funding Information: The RADAR-CNS project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115902. This Joint Undertaking receives support from the European Union{\textquoteright}s Horizon 2020 research and innovation programme and EFPIA ( www.imi.europa.eu ). This communication reflects the views of the RADAR-CNS Consortium and neither IMI nor the European Union and EFPIA are liable for any use that may be made of the information contained herein. Morover, the work was supported by the Grant TED2021-131106B-I00 funded by MCIN/AEI/ 10.13039/501100011033 and by the “European Union NextGenerationEU/PRTR”. Publisher Copyright: Copyright {\textcopyright} 2023 Kontaxis, Laporta, Garcia, Guerrero, Zabalza, Matteo, Lucia, Simblett, Weyer, Hotopf, Narayan, Rashid, Folarin, Dobson, Buron, Leocani, Cummins, Vairavan, Costa, Magyari, S{\o}rensen, Nos, Bail{\'o}n, Comi and the RADAR-CNS Consortium.",

year = "2023",

doi = "10.3389/fphys.2023.1145818",

language = "English",

volume = "14",

pages = "1145818",

journal = "Frontiers in Physiology",

issn = "1664-042X",

publisher = "Frontiers",

}

Kontaxis, S, Laporta, E, Garcia, E, Guerrero, AI, Zabalza, A, Matteo, M, Lucia, R, Simblett, S, Weyer, J, Hotopf, M, Narayan, VA, Rashid, Z , Folarin, AA , Dobson, RJB, Buron, MD, Leocani, L, Cummins, N, Vairavan, S, Costa, GD, Magyari, M, Sørensen, PS, Nos, C, Bailón, R, Comi, G & The Radar-Cns Consortium 2023, 'Autonomic response to walk tests is useful for assessing outcome measures in people with multiple sclerosis', Frontiers in Physiology, vol. 14, 1145818, pp. 1145818. https://doi.org/10.3389/fphys.2023.1145818

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, null

N1 - 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. Funding Information: The RADAR-CNS project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115902. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA (www.imi.europa.eu). This communication reflects the views of the RADAR-CNS Consortium and neither IMI nor the European Union and EFPIA are liable for any use that may be made of the information contained herein. Morover, the work was supported by the Grant TED2021-131106B-I00 funded by MCIN/AEI/ 10.13039/501100011033 and by the “European Union NextGenerationEU/PRTR”. Funding Information: The RADAR-CNS project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115902. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA ( www.imi.europa.eu ). This communication reflects the views of the RADAR-CNS Consortium and neither IMI nor the European Union and EFPIA are liable for any use that may be made of the information contained herein. Morover, the work was supported by the Grant TED2021-131106B-I00 funded by MCIN/AEI/ 10.13039/501100011033 and by the “European Union NextGenerationEU/PRTR”. 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.

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 - Article

C2 - 37089424

SN - 1664-042X

VL - 14

SP - 1145818

JO - Frontiers in Physiology

JF - Frontiers in Physiology

M1 - 1145818

ER -

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

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