Heart rate circadian profile in the differential diagnosis between Parkinson disease and multiple system atrophy |
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| Affiliation: | 1. Department of Parkinson''s Disease and Movement Disorders, IRCCS San Camillo, Venice-Lido, Italy;2. Department of Cardiology, IRCCS San Camillo, Venice, Italy;3. Department of Rehabilitation of Cerebral Lesions, IRCCS San Camillo, Venice, Italy;1. Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada;2. Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada;3. Division of Neurology, University Health Network Memory Clinic, Toronto, Ontario, Canada;1. Department of Neurology, Baylor College of Medicine, Houston, TX, USA;2. Department of Genetics, Baylor College of Medicine, Houston, TX, USA;3. The Methodist Hospital, Houston, TX, USA;4. Texas Tech University Health Sciences Center, Lubbock, TX, USA;5. IST High Performance & Research Computing, University of Medicine and Dentistry of NJ, Newark, NJ, USA;6. University of Texas Health Science Center at Houston, Houston, TX, USA;1. Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy;2. Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy;3. Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands;4. Department of Neurophysiology, San Gennaro Hospital, Naples, Italy;5. Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy;1. Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland;2. Department of Surgery, University of Maryland Baltimore, School of Medicine, Baltimore, Maryland;3. Department of Pathology, University of Maryland Medical Center, Baltimore, Maryland;4. Revivicor Inc, Blacksburg, Virginia |
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| Abstract: | Clinical diagnostic criteria indicate presence of autonomic features as the primary hallmark of Multiple System Atrophy (MSA). However involvement of the autonomic system is also a recognized feature of Parkinson's Disease (PD), yielding a broad clinical overlap between the two diseases. Laboratory assessments may help in the differential diagnosis between PD and MSA. Ambulatory Monitoring of Blood Pressure (AMBP) is a suitable tool to study the circadian rhythm of blood pressure (BP) and heart rate (HR). Different studies reported a reduction of physiological BP nocturnal dipping in PD and MSA patients, but failed to identify a distinctive pattern discriminating the two diseases. On the other hand, HR nocturnal behavior has not been exhaustively analyzed. In the present study we compared the profiles of HR circadian rhythm in 61 PD and 19 MSA patients who underwent 24 h AMBP.We found higher nocturnal HR (nHR) (71.5 beats/min ± 7.4) in MSA compared with PD (63.8 beats/min ± 9.6) as well as significantly lower nocturnal decline of HR (ndHR) in MSA (7.3% ± 8.2) vs. PD (14% ± 7.5). At a Receiver Operating Curve analysis nHR and ndHR significantly discriminated MSA from PD. nHR showed a sensitivity of 84.2% and a specificity of 62.3% (AUC 0.76; 95% IC 0.65–0.85); ndHR showed a sensitivity of 68% of and a specificity of 77% (AUC 0.72; 95% IC 0.61–0.82).According to our findings, nHR is increased and ndHR is reduced in MSA compared to PD. Moreover, these two indices discriminate between the two diseases with acceptable accuracy. |
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| Keywords: | Parkinson disease Multiple system atrophy Differential diagnosis Dysautonomia Cardiovascular function Heart rate |
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