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

Manuela Pilleri, Giorgio Levedianos, Luca Weis, Elisabetta Gasparoli, Silvia Facchini, Roberta Biundo, Patrizia Formento-Dojot, Angelo Antonini

Research output: Contribution to journalArticle

13 Citations (Scopus)

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 19MSA patients who underwent 24h AMBP.We found higher nocturnal HR (nHR) (71.5beats/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.

Original languageEnglish
Pages (from-to)217-221
Number of pages5
JournalParkinsonism and Related Disorders
Volume20
Issue number2
DOIs
Publication statusPublished - Feb 2014

Fingerprint

Multiple System Atrophy
Parkinson Disease
Differential Diagnosis
Heart Rate
Ambulatory Blood Pressure Monitoring
Circadian Rhythm
Area Under Curve
Blood Pressure

Keywords

  • Cardiovascular function
  • Differential diagnosis
  • Dysautonomia
  • Heart rate
  • Multiple system atrophy
  • Parkinson disease

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Clinical Neurology
  • Neurology

Cite this

Heart rate circadian profile in the differential diagnosis between Parkinson disease and multiple system atrophy. / Pilleri, Manuela; Levedianos, Giorgio; Weis, Luca; Gasparoli, Elisabetta; Facchini, Silvia; Biundo, Roberta; Formento-Dojot, Patrizia; Antonini, Angelo.

In: Parkinsonism and Related Disorders, Vol. 20, No. 2, 02.2014, p. 217-221.

Research output: Contribution to journalArticle

Pilleri, M, Levedianos, G, Weis, L, Gasparoli, E, Facchini, S, Biundo, R, Formento-Dojot, P & Antonini, A 2014, 'Heart rate circadian profile in the differential diagnosis between Parkinson disease and multiple system atrophy', Parkinsonism and Related Disorders, vol. 20, no. 2, pp. 217-221. https://doi.org/10.1016/j.parkreldis.2013.11.006
Pilleri, Manuela ; Levedianos, Giorgio ; Weis, Luca ; Gasparoli, Elisabetta ; Facchini, Silvia ; Biundo, Roberta ; Formento-Dojot, Patrizia ; Antonini, Angelo. / Heart rate circadian profile in the differential diagnosis between Parkinson disease and multiple system atrophy. In: Parkinsonism and Related Disorders. 2014 ; Vol. 20, No. 2. pp. 217-221.
@article{228583a9d11d4243b3cfb22d43e3cdcb,
title = "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 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 19MSA patients who underwent 24h AMBP.We found higher nocturnal HR (nHR) (71.5beats/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.",
keywords = "Cardiovascular function, Differential diagnosis, Dysautonomia, Heart rate, Multiple system atrophy, Parkinson disease",
author = "Manuela Pilleri and Giorgio Levedianos and Luca Weis and Elisabetta Gasparoli and Silvia Facchini and Roberta Biundo and Patrizia Formento-Dojot and Angelo Antonini",
year = "2014",
month = "2",
doi = "10.1016/j.parkreldis.2013.11.006",
language = "English",
volume = "20",
pages = "217--221",
journal = "Parkinsonism and Related Disorders",
issn = "1353-8020",
publisher = "Elsevier BV",
number = "2",

}

TY - JOUR

T1 - Heart rate circadian profile in the differential diagnosis between Parkinson disease and multiple system atrophy

AU - Pilleri, Manuela

AU - Levedianos, Giorgio

AU - Weis, Luca

AU - Gasparoli, Elisabetta

AU - Facchini, Silvia

AU - Biundo, Roberta

AU - Formento-Dojot, Patrizia

AU - Antonini, Angelo

PY - 2014/2

Y1 - 2014/2

N2 - 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 19MSA patients who underwent 24h AMBP.We found higher nocturnal HR (nHR) (71.5beats/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.

AB - 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 19MSA patients who underwent 24h AMBP.We found higher nocturnal HR (nHR) (71.5beats/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.

KW - Cardiovascular function

KW - Differential diagnosis

KW - Dysautonomia

KW - Heart rate

KW - Multiple system atrophy

KW - Parkinson disease

UR - http://www.scopus.com/inward/record.url?scp=84893663785&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84893663785&partnerID=8YFLogxK

U2 - 10.1016/j.parkreldis.2013.11.006

DO - 10.1016/j.parkreldis.2013.11.006

M3 - Article

VL - 20

SP - 217

EP - 221

JO - Parkinsonism and Related Disorders

JF - Parkinsonism and Related Disorders

SN - 1353-8020

IS - 2

ER -