Abstract：
OBJECTIVE: Hypermetabolic state in Graves\' disease (GD) has a great impact on heart homeostasis, acting directly on the heart muscle and modulating the autonomic nervous system. To characterize cardiac autonomic neuropathy (CAN) as a possible complication in patients with GD.
METHODS: We evaluated euthyroid GD patients and a control group of healthy euthyroid people. CAN was assessed using autonomic tests of cardiovascular reflex and heart rate variability: respiratory, Valsalva, orthostatic and orthostatic hypotension tests, high frequency, low frequency, and very low-frequency bands. Transthoracic echocardiography was performed in GD patients.
RESULTS: Sixty GD patients and 50 people in control group were assessed. CAN was diagnosed in 20% of GD and 14% in the control group. Among GD, 13.3% presented incipient, and 6.7% established CAN, while in the control group, it was verified incipient in 8% and established in 6% (P = .7479). All GD patients with CAN presented an alteration in the deep breathing test. Age and smoking were evidenced as factors associated with the presence of CAN, while higher TRAb values at diagnosis decreased the chance of CAN.
CONCLUSIONS: The prevalence of CAN in euthyroid GD patients was 20%. Changes in the cardiac autonomic nervous system were identified, pointing to the importance of evaluating this complication in these patients. Smoking was a predictive factor for CAN, increasing its relationship with conditions that aggravate GD.
METHODS: We evaluated euthyroid GD patients and a control group of healthy euthyroid people. CAN was assessed using autonomic tests of cardiovascular reflex and heart rate variability: respiratory, Valsalva, orthostatic and orthostatic hypotension tests, high frequency, low frequency, and very low-frequency bands. Transthoracic echocardiography was performed in GD patients.
RESULTS: Sixty GD patients and 50 people in control group were assessed. CAN was diagnosed in 20% of GD and 14% in the control group. Among GD, 13.3% presented incipient, and 6.7% established CAN, while in the control group, it was verified incipient in 8% and established in 6% (P = .7479). All GD patients with CAN presented an alteration in the deep breathing test. Age and smoking were evidenced as factors associated with the presence of CAN, while higher TRAb values at diagnosis decreased the chance of CAN.
CONCLUSIONS: The prevalence of CAN in euthyroid GD patients was 20%. Changes in the cardiac autonomic nervous system were identified, pointing to the importance of evaluating this complication in these patients. Smoking was a predictive factor for CAN, increasing its relationship with conditions that aggravate GD.
摘要：
背景：Graves病（GD）的高代谢状态对心脏稳态有很大影响，直接作用于心肌并调节自主神经系统。
目的：探讨心脏自主神经病变（CAN）作为GD患者可能的并发症。
方法：我们评估了甲状腺功能正常的GD患者和健康甲状腺功能正常的对照组。使用心血管反射和心率变异性的自主神经测试评估CAN：呼吸，瓦尔萨尔瓦,直立性和直立性低血压试验，高频,低频,和非常低的频段。对GD患者进行了经胸超声心动图检查。
结果：评估60例GD患者和50例对照组患者。在GD的20％和对照组的14％中诊断出CAN。在GD中，13.3%出现初期，和6.7%，已建立的CAN,而在对照组中，它在8%的初始验证和6%的建立(p=0.7479)。所有患有CAN的GD患者在深呼吸测试中表现出改变。年龄和吸烟被证明是与CAN存在相关的因素，而诊断时较高的TRAb值降低了NAC的机会。
结论：甲状腺功能正常的GD患者中CAN的患病率为20%。确定了心脏自主神经系统的变化，指出在这些患者中评估这种并发症的重要性。吸烟是CAN的预测因素，增加其与加重GD的条件的关系。
目的：探讨心脏自主神经病变（CAN）作为GD患者可能的并发症。
方法：我们评估了甲状腺功能正常的GD患者和健康甲状腺功能正常的对照组。使用心血管反射和心率变异性的自主神经测试评估CAN：呼吸，瓦尔萨尔瓦,直立性和直立性低血压试验，高频,低频,和非常低的频段。对GD患者进行了经胸超声心动图检查。
结果：评估60例GD患者和50例对照组患者。在GD的20％和对照组的14％中诊断出CAN。在GD中，13.3%出现初期，和6.7%，已建立的CAN,而在对照组中，它在8%的初始验证和6%的建立(p=0.7479)。所有患有CAN的GD患者在深呼吸测试中表现出改变。年龄和吸烟被证明是与CAN存在相关的因素，而诊断时较高的TRAb值降低了NAC的机会。
结论：甲状腺功能正常的GD患者中CAN的患病率为20%。确定了心脏自主神经系统的变化，指出在这些患者中评估这种并发症的重要性。吸烟是CAN的预测因素，增加其与加重GD的条件的关系。
