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Review
. 2020 Jan 24;9(2):335.
doi: 10.3390/jcm9020335.

Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies

Oliver Findling  1   2 , Larissa Hauer  3 , Thomas Pezawas  4 , Paulus S Rommer  5 , Walter Struhal  2 , Johann Sellner  6   7   8
Affiliations
Review

Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies

Oliver Findling et al. J Clin Med. .

Abstract

Cardiac autonomic dysfunction (CAD) has been reported in patients with multiple sclerosis (MS). This systematic review summarizes the evidence for the types and prevalence of CAD in MS patients, as well as its association with MS type, disease characteristics, fatigue and immunotherapies used to treat MS. The analysis revealed that CAD is correlated with pathophysiological processes of MS, can trigger serious cardiovascular complications that may reduce life expectancy, and may have implications for treatment with immunotherapies, especially fingolimod. Numerous mainly small case-control or cohort studies have reported various measures of CAD (particularly heart rate variation) in MS patients, showing higher rates of abnormality versus controls. A smaller number of studies have reported on cardiac autonomic symptoms in MS, including orthostatic intolerance/dizziness in around 50% of patients. CAD also appears to be associated with disease duration and to be more common in progressive than relapsing-remitting MS. However, although a substantial evidence base suggests that assessing CAD in people with MS may be important, standardised methods to evaluate CAD in these patients have not yet been established. In addition, no studies have yet looked at whether treating CAD can reduce the burden of MS symptoms, disease activity or the rate of progression.

Keywords: cardiac autonomic dysfunction; fingolimod; heart rate variability; multiple sclerosis; orthostatic intolerance.

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Conflict of interest statement

O.F. reports personal fees, speaker honoraria or travel support from Bayer Schweiz A.G., Novartis, Teva, Sanofi Genzyme, Biogen, Roche, Merck and Almirall; and has received research support from the Swiss M.S. Society. L.H. reports no conflicts. T.P. reports no conflicts. W.S. has received speaker honoraria from Abbvie, Ever Neuropharma and Pfizer; has served on advisory boards from Boehringer and Lilly; and received royalities from Springer, Manz and Oxford University Press. P.S.R. has received speaker honoraria from Biogen, Merck, Roche, Sanofi Genzyme, Shire; has served on advisory boards or received honoraria for consultancy from Biogen, Merck, Roche, Teva; and has received research grant support from Biogen, Merck, Roche. JS has received speaker honoraria from Biogen, GL-Pharma, Merck, Novartis, Roche, Sanofi and Teva; serves on advisory boards for Alexion, Biogen, Celgene Merck, Novartis, Roche, Sanofi and Teva; and has received research support from Biogen, Roche and Merck.

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