Heart rate circadian profile in the differential diagnosis between Parkinson disease and multiple system atrophy

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 disease...

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Veröffentlicht in:Parkinsonism & related disorders 2014-02, Vol.20 (2), p.217-221
Hauptverfasser: Pilleri, Manuela, Levedianos, Giorgio, Weis, Luca, Gasparoli, Elisabetta, Facchini, Silvia, Biundo, Roberta, Formento-Dojot, Patrizia, Antonini, Angelo
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container_end_page 221
container_issue 2
container_start_page 217
container_title Parkinsonism & related disorders
container_volume 20
creator Pilleri, Manuela
Levedianos, Giorgio
Weis, Luca
Gasparoli, Elisabetta
Facchini, Silvia
Biundo, Roberta
Formento-Dojot, Patrizia
Antonini, Angelo
description 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.
doi_str_mv 10.1016/j.parkreldis.2013.11.006
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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. 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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. 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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.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>24290883</pmid><doi>10.1016/j.parkreldis.2013.11.006</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-2286-0795</orcidid></addata></record>
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subjects Aged
Area Under Curve
Autonomic Nervous System - physiopathology
Autonomic Nervous System Diseases - diagnosis
Blood Pressure Monitoring, Ambulatory
Cardiovascular function
Circadian Rhythm - physiology
Cross-Sectional Studies
Diagnosis, Differential
Differential diagnosis
Dysautonomia
Female
Heart rate
Heart Rate - physiology
Humans
Male
Middle Aged
Multiple system atrophy
Multiple System Atrophy - diagnosis
Multiple System Atrophy - physiopathology
Neurology
Parkinson disease
Parkinson Disease - diagnosis
Parkinson Disease - physiopathology
ROC Curve
title Heart rate circadian profile in the differential diagnosis between Parkinson disease and multiple system atrophy
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