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.

Keywords: ECG-derived respiration; autonomic nervous system; disability; fatigue; heart rate variability; relapsing-remitting multiple sclerosis; secondary progressive multiple sclerosis; walking capacity.

FIGURE 1

HRV analysis during the 2MWT (A) HRV signal, (B) EDR signal, (C) HR profile, and (D) HRV spectrum.

FIGURE 2

Boxplots of HRV and respiratory parameters for different groups of pwMS. Groups based on (A–D) phenotype, (E–H) fatigue severity, (I–L) disability level, and (M–P) walking capacity. Statistically significant group differences are denoted with an asterisk.

FIGURE 3

Scatter plots of the most significant ANS parameters for each clinical outcome measure (A) FSS, (B) EDSS, (C) 2MWT, and (D) 6MWT. A blue and red line are fitted to the data of RRMS and SPMS group, respectively, while a black line is fitted to the data without taking into account the phenotype of the disorder.

FIGURE 4

Scatter plots of the most significant ANS parameters derived during 2MWT performed at hospital and at home. (A) ${\sigma }_r^{\mathcal{T}}$ , (B) ${\mathrm{H}\mathrm{R}\mathrm{M}}_{\mathcal{T}}$ , (C) ${\mathrm{H}\mathrm{R}\mathrm{M}}_{{\mathcal{T}}_1}$ , and (D) ${\mathrm{H}\mathrm{R}\mathrm{M}}_{{\mathcal{T}}_2}$ .