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 journalArticlepeer-review


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
Issue number2
Publication statusPublished - Feb 2014


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

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Clinical Neurology
  • Neurology


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