Evaluating exercise challenge to validate cardiac autonomic dysfunction in lean PCOS phenotype

Abha Mishra; Renuka Sharma; Pratima Mittal; Raj Kapoor; Shival Srivastav

doi:10.1515/jbcpp-2018-0198

Article

Evaluating exercise challenge to validate cardiac autonomic dysfunction in lean PCOS phenotype

Abha Mishra , Renuka Sharma , Pratima Mittal , Raj Kapoor and Shival Srivastav

Published/Copyright: May 16, 2019

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From the journal Journal of Basic and Clinical Physiology and Pharmacology Volume 30 Issue 4

Abstract

Background

Polycystic ovary syndrome (PCOS) is frequently associated with infertility, obesity, hypertension, and diabetes mellitus. Cardiac autonomic dysfunction is well documented in long-term patients of PCOS, with impairment being proportionate to disease duration. However, there is paucity of literature on cardiac autonomic tone in the “lean” phenotype of PCOS. We used exercise challenge to probe for autonomic dysfunction, as assessed by heart rate variability (HRV), an index of cardiac autonomic tone.

Methods

Our study population consisted of 27 newly diagnosed PCOS patients and 25 healthy females matched by age and body mass index. Short-term HRV was assessed using time and frequency domain indices. Moderate, isotonic exercise was used as an interventional tool. Indices of both groups were compared in three bins – at baseline, immediate, and late postexercise stages.

Results

The groups had comparable HRV indices at baseline. However, low-frequency (LF) power was significantly reduced in PCOS patients during immediate and late postexercise phases when compared with controls (p = 0.03 and 0.03, respectively). Time domain indices also exhibited a fall postexercise, although not statistically significant.

Conclusions

Although “lean” phenotype PCOS patients had comparable HRV parameters as controls at baseline, the administration of exercise challenge led to reduced sympathetic drive, evident by reduced LF power in patient group. This may be due to latent autonomic dysfunction in “lean” PCOS, which is unmasked on exposure to exercise challenge. We propose that the evaluation of HRV response to exercise may serve as a sensitive screening tool to detect early cardiovascular dysfunction in newly diagnosed lean PCOS patients.

Keywords: exercise testing; heart rate variability; polycystic ovary syndrome

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The authors state no potential conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The research related to human use has been complied with all the relevant national regulations and institutional policies and in accordance the tenets of the Declaration of Helsinki, and it has been approved by the authors’ institutional review board or equivalent committee.

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Received: 2018-11-11

Accepted: 2019-03-22

Published Online: 2019-05-16

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Articles in the same Issue

https://doi.org/10.1515/jbcpp-2018-0198

Keywords for this article

exercise testing; heart rate variability; polycystic ovary syndrome