Pulmonary hypertension in systemic sclerosis determines cardiac autonomic dysfunction assessed by heart rate turbulence

There is limited data on heart rate turbulence (HRT) in systemic sclerosis (SSc) patients, potentially threatened with cardiac autonomic dysfunction. We performed 24-hour Holter monitoring for HRT assessment in 45 patients with SSc and 30 healthy controls. Abnormal HRT defined as turbulence onset (TO) ≥ 0.0% and/or turbulence slope (TS) ≤ 2.5 ms/RR was found in 19 (42%) of SSc patients while not in controls. HRT was significantly impaired in SSc group, as compared to controls: a median of TO was higher (− 0.13 vs. − 2.45%, p = 0.0001), and a median of TS was lower (6.90 vs. 13.21 ms/RR, p = 0.0003), respectively. Multivariate analysis showed that abnormal HRT in SSc was significantly influenced by pulmonary hypertension (PH) (OR 6.1, 1.1–48.6; p = 0.049) and older age (OR 1.8, 95%CI 1.1–3.5; p = 0.03). In conclusion, HRT assessment indicates a frequent impairment of cardiac autonomic nervous system in SSc patients. Moreover, older age in these patients and especially PH are independent significant predictors of cardiac autonomic dysfunction.