1. Screening indexes for cardiovascular autonomic failure in Parkinson's disease
- Author
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C. Di Stefano, M. Valente, Gabriele Sobrero, Simona Maule, M. Giudici, Valeria Milazzo, and Fabrizio Vallelonga
- Subjects
medicine.medical_specialty ,Ambulatory blood pressure ,Parkinson's disease ,business.industry ,Blood Pressure ,Blood Pressure Determination ,Parkinson Disease ,Autonomic Nervous System ,medicine.disease ,Hypotension, Orthostatic ,Orthostatic vital signs ,Blood pressure ,Autonomic Nervous System Diseases ,Neurology ,Internal medicine ,Heart rate ,Cardiology ,Humans ,Medicine ,In patient ,Neurology (clinical) ,Autonomic testing ,business ,Pure autonomic failure - Abstract
Autonomic failure (AF) is a common source of orthostatic hypotension (OH) in Parkinson's disease (PD). The diagnosis of AF is difficult on clinical grounds alone. We used autonomic testing and 24-h BP monitoring (ABPM) in 122 PD patients to evaluate the diagnostic accuracy of AF by (1) the reduced heart rate increase to fall in blood pressure (BP) ratio (ΔHR/ΔSBP), (2) reverse dipping (RD), and (3) increased diurnal systolic BP standard deviation (SD-SBP). Among patients with OH, ΔHR/ΔSBP yielded the best accuracy (85%), with excellent sensitivity (92%) and acceptable specificity (67%). RD and, to a lesser extent, SD-SBP had high specificity (93% and 73%, respectively) but low sensitivity, resulting in overall moderate accuracy (66% and 55%, respectively). In patients with OH, the addition of ABPM indexes to ΔHR/ΔSBP did not result in a significant improvement of accuracy. In patients without OH, RD and SD-SBP may be useful showing an accuracy of 72% and 81%, respectively, with high negative predictive value when both RD and increased SD-SBP are absent. The integration of bedside (∆HR/∆SBP) and ABPM-derived indexes can assist the clinician in screening PD patients for AF and guide referral to autonomic testing.
- Published
- 2021
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