Cardiovascular autonomic testing performed with a new integrated instrumental approach is useful in differentiating MSA-P from PD at an early stage
Abstract
Objective To evaluate whether a battery of cardiovascular autonomic tests (Ewing's battery, EB) performed with a new integrated instrumental approach is useful in differentiating multiple system atrophy with predominant parkinsonism (MSA-P) from Parkinson's disease (PD) at an early stage.Methods We retrospectively analyzed EB tests of all the patients (n = 99) with a parkinsonian syndrome referred to our clinic who performed EB during the first diagnostic workup and were subsequently evaluated at least once a year until a final diagnosis of MSA-P (n = 34) or PD (n = 65). Thirty-eight controls matched for age and sex were included. EB consisted of head-up tilt test (HUTT), Valsalva manoeuvre (VM), deep breathing, and sustained handgrip whose correct execution and results were checked and obtained automatically. Results were compared between groups. Discriminant analysis was performed to identify MSA-P or PD patients.Results Orthostatic hypotension was found in 22 MSA-P and 3 PD patients. Cardiovascular reflexes indices were significantly more affected in MSA-P compared to PD and controls. EB presented a 91% sensitivity and 94% specificity in the differentiation of MSA-P and PD. HUTT + VM presented a 91% sensitivity and 92% specificity.Conclusions Our results suggest that EB or HUTT + VM performed with an integrated instrumental approach and analyzed with the discriminant procedure may distinguish MSA-P from PD at an early stage and might improve the accuracy of current diagnostic criteria. However, a validation in separate samples and prospective studies is needed.
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The absence of a BP overshoot and an absence of a HR increase during the Valsalva is pathognomonic for neurogenic OH, occurring in primary and secondary autonomic failure.
“There is strong evidence that the absence of a BP overshoot and an absence of a HR increase during the Valsalva is pathognomonic for neurogenic OH, occurring in primary and secondary autonomic failure, and the degree of hypotension and/or lack of compensation during forced expiration usually correlate with the degree of autonomic dysfunction and related symptoms. 138-143”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [142]
Blunted or abolished variation in HR during deep breathing is suggestive of parasympathetic dysfunction.
“There is strong consensus that blunted or abolished variation is suggestive of parasympathetic dysfunction. 142,143,146,147”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [142]
The degree of hypotension and/or lack of compensation during forced expiration usually correlate with the degree of autonomic dysfunction and related symptoms.
“There is strong evidence that the absence of a BP overshoot and an absence of a HR increase during the Valsalva is pathognomonic for neurogenic OH, occurring in primary and secondary autonomic failure, and the degree of hypotension and/or lack of compensation during forced expiration usually correlate with the degree of autonomic dysfunction and related symptoms. 138-143”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [142]
There is weak evidence that other autonomic function tests (30:15 ratio, cold pressure test, sustained hand grip test, and mental arithmetic) may be useful.
“There is weak evidence that these tests may be useful. 13,142,143,147”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [142]
Cites
Systematic review of levodopa dose equivalency reporting in Parkinson's disease
Tomlinson, C. L., Stowe, R. L., Patel, S., Rick, C., Gray, R. G., & Clarke, C. E. (2010) · Movement Disorders · doi:10.1002/mds.23429 · Cited by 4,232 · see citing works
Second consensus statement on the diagnosis of multiple system atrophy
Gilman, S., Wenning, G. K., Low, P. A., Brooks, D. J., Mathias, C. J., Trojanowski, J. Q., Wood, N. W., Colosimo, C., Dürr, A., Fowler, C. J., et al. (2008) · Neurology · doi:10.1212/01.wnl.0000324625.00404.15 · Cited by 3,140 · see citing works
Diagnostic Criteria for Parkinson Disease
Gelb, D. J., Oliver, E., & Gilman, S. (1999) · Archives of Neurology · doi:10.1001/archneur.56.1.33 · Cited by 2,822 · see citing works
Freeman, R., Wieling, W., Axelrod, F. B., Benditt, D. G., Benarroch, E., Biaggioni, I., Cheshire, W. P., Chelimsky, T., Cortelli, P., Gibbons, C. H., et al. (2011) · Clinical Autonomic Research · doi:10.1007/s10286-011-0119-5 · Cited by 1,697 · cited 2× · see citing works
“We found OH [4] in 20/34 MSA-P and in 3/65 PD patients.”
BackgroundSelf-citationFreeman, R., Wieling, W., Axelrod, F. B., Benditt, D. G., Benarroch, E., Biaggioni, I., Cheshire, W. P., Chelimsky, T., Cortelli, P., Gibbons, C. H., et al. (2011) · Autonomic Neuroscience · doi:10.1016/j.autneu.2011.02.004 · Cited by 1,243 · see citing works
Self-citationThe natural history of multiple system atrophy: a prospective European cohort study
Wenning, G. K., Geser, F., Krismer, F., Seppi, K., Duerr, S., Boesch, S., Köllensperger, M., Goebel, G., Pfeiffer, K. P., Barone, P., et al. (2013) · The Lancet Neurology · doi:10.1016/s1474-4422(12)70327-7 · Cited by 545 · see citing works
Berg, D., Postuma, R. B., Bloem, B. R., Chan, P., Dubois, B., Gasser, T., Goetz, C. G., Halliday, G. M., Hardy, J., Lang, A. E., et al. (2014) · Movement Disorders · doi:10.1002/mds.25844 · Cited by 502 · see citing works
Multiple system atrophy: an update
Stefanova, N., Bücke, P., Duerr, S., & Wenning, G. K. (2009) · The Lancet Neurology · doi:10.1016/s1474-4422(09)70288-1 · Cited by 374 · see citing works
Prevalence of orthostatic hypotension in Parkinson’s disease: A systematic review and meta-analysis
Velseboer, D. C., de Haan, R. J., Wieling, W., Goldstein, D. S., & de Bie, R. M. A. (2011) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2011.04.016 · Cited by 356 · see citing works
Cardiovascular dysautonomia in Parkinson disease: From pathophysiology to pathogenesis
Jain, S., & Goldstein, D. S. (2011) · Neurobiology of Disease · doi:10.1016/j.nbd.2011.10.025 · Cited by 299 · see citing works
Wenning, G. K. (2000) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.68.4.434 · Cited by 261 · see citing works
Autonomic failure as the initial presentation of Parkinson disease and dementia with Lewy bodies
Kaufmann, H., Nahm, K., Purohit, D. P., & WOLFE, D. E. (2004) · Neurology · doi:10.1212/01.wnl.0000138500.73671.dc · Cited by 239 · see citing works
Blood pressure recovery from Valsalva maneuver in patients with autonomic failure
Vogel, E. R., Sandroni, P., & Low, P. A. (2005) · Neurology · doi:10.1212/01.wnl.0000184504.13173.ef · Cited by 160 · see citing works
Lipp, A., Sandroni, P., Ahlskog, J. E., Fealey, R. D., Kimpinski, K., Iodice, V., Gehrking, T. L., Weigand, S. D., Sletten, D. M., Gehrking, J. A., et al. (2009) · Archives of Neurology · doi:10.1001/archneurol.2009.71 · Cited by 154 · see citing works
Plasma levels of catechols and metanephrines in neurogenic orthostatic hypotension
Goldstein, D. S., Holmes, C. S., Sharabi, Y., Brentzel, S., & Eisenhofer, G. (2003) · Neurology · doi:10.1212/01.wnl.0000058766.46428.f3 · Cited by 136 · see citing works
Autonomic involvement in extrapyramidal and cerebellar disorders
Sandroni, P., Ahlskog, J. E., Fealey, R. D., & Low, P. A. (1991) · Clinical Autonomic Research · doi:10.1007/bf01826212 · Cited by 132 · see citing works
Petrovic, I. N., Ling, H., Asi, Y. T., Ahmed, Z., Kukkle, P. L., Hazrati, L., Lang, A. E., Révész, T., Holton, J. L., & Lees, A. J. (2012) · Movement Disorders · doi:10.1002/mds.25115 · Cited by 121 · see citing works
Kimber, J., Watson, L. P. E., & Mathias, C. J. (1997) · The Lancet · doi:10.1016/s0140-6736(96)10168-9 · Cited by 119 · see citing works
Iodice, V., Lipp, A., Ahlskog, J. E., Sandroni, P., Fealey, R. D., Parisi, J. E., Matsumoto, J. Y., Benarroch, E. E., Kimpinski, K., Singer, W., et al. (2012) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2011-301068 · Cited by 111 · see citing works
Köllensperger, M., Seppi, K., Liener, C., Boesch, S., Heute, D., Mair, K. J., Mueller, J., Sawires, M., Scherfler, C., Schocke, M. F. H., et al. (2007) · Movement Disorders · doi:10.1002/mds.21614 · Cited by 92 · see citing works
Riley, D. E. (2002) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.74.1.56 · Cited by 88 · see citing works
Cardiovascular autonomic dysfunction in MSA and Parkinson's disease: Similarities and differences
Iodice, V., Low, D. A., Vichayanrat, E., & Mathias, C. J. (2011) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2011.07.014 · Cited by 81 · see citing works
Holmberg, B., Kallio, M., Johnels, B., & Elam, M. (2001) · Movement Disorders · doi:10.1002/mds.1062 · Cited by 80 · see citing works
The potential prognostic role of cardiovascular autonomic failure in α‐synucleinopathies
Fanciulli, A., Strano, S., Colosimo, C., Caltagirone, C., Spalletta, G., & Pontieri, F. E. (2013) · European Journal of Neurology · doi:10.1111/j.1468-1331.2012.03819.x · Cited by 77 · see citing works
Kimpinski, K., Iodice, V., Burton, D. D., et al. (2012) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2012.02.023 · Cited by 57 · see citing works
New findings on the neuropathology of multiple system atrophy
Benarroch, E. E. (2002) · Autonomic Neuroscience · doi:10.1016/s1566-0702(01)00374-5 · Cited by 56 · see citing works
Reimann, M., Schmidt, C., Herting, B., Prieur, S., Junghanns, S., Schweitzer, K. J., Globas, C., Schöls, L. J., Reichmann, H., Berg, D., et al. (2009) · Journal of Neural Transmission · doi:10.1007/s00702-009-0313-y · Cited by 51 · see citing works
Valsalva manoeuvre in patients with different Parkinsonian disorders
Schmidt, C., Herting, B., Prieur, S., et al. (2009) · Journal of Neural Transmission · doi:10.1007/s00702-009-0239-4 · Cited by 48 · see citing works
A new integrated instrumental approach to autonomic nervous system assessment
Corazza, I., Barletta, G., Guaraldi, P., Cecere, A., Buonaura, G. C., Altini, E., Zannoli, R., & Cortelli, P. (2014) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2014.08.002 · Cited by 45 · see citing works
Self-citationCardiovascular autonomic nervous system evaluation in Parkinson disease and multiple system atrophy
Brisinda, D., Sorbo, A. R., Giacopo, R. D., Venuti, A., Bentivoglio, A. R., & Fenici, R. (2013) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2013.10.039 · Cited by 37 · see citing works
Multiple system atrophy with prolonged survival: is late onset of dysautonomia the clue?
Buonaura, G. C., Guaraldi, P., Sambati, L., Lopane, G., Cecere, A., Barletta, G., Provini, F., Contin, M., Martinelli, P., & Cortelli, P. (2013) · Neurological Sciences · doi:10.1007/s10072-013-1470-1 · Cited by 37 · see citing works
Self-citationUmemura, A., Oeda, T., Hayashi, R., Tomita, S., Kohsaka, M., Yamamoto, K., & Sawada, H. (2013) · PLoS ONE · doi:10.1371/journal.pone.0061066 · Cited by 32 · see citing works
TESTING FOR AUTONOMIC NEUROPATHY
Ewing, D. J. (1981) · The Lancet · doi:10.1016/s0140-6736(81)90104-5 · Cited by 11 · see citing works
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2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951 · see citing works
Rocchi, C., Pierantozzi, M., Galati, S., Chiaravalloti, A., Pisani, V., Prosperetti, C., Lauretti, B., Stampanoni Bassi, M., Olivola, E., Schillaci, O., et al. (2015) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.12437 · Cited by 31 · see citing works
- Authors
- Baschieri, F., Calandra-Buonaura, G., Doria, A., Mastrolilli, F., Palareti, A., Barletta, G., Solieri, L., Guaraldi, P., Martinelli, P., & Cortelli, P.
- Affiliations
- University of Bologna (IT)
- Queen Elizabeth Hospital (GB)
- Ospedale Bellaria (IT)
- Corresponding author
- Baschieri, Francesca
- Doria, Andrea
- Mastrolilli, Francesca
- Palareti, Aldopaolo
- Barletta, Giorgio
- Solieri, Laura
- Guaraldi, Pietro
- Martinelli, Paolo
- Cortelli, Pietro
- ORCID
- Venue
- Parkinsonism & Related Disorders
- Publisher
- Elsevier BV
- Published
- 2015-05
- Volume
- 21
- Issue
- 5
- Pages
- 477-482
- ISSN
- 1353-8020 (ISSN-L)
- OpenAlex
- W1966017940
- Cited by
- 55
- References
- 33
- Citations by year
- 2026: 2 · 2025: 3 · 2023: 3 · 2022: 3 · 2021: 4 · 2020: 8 · 2019: 2 · 2018: 7 · 2017: 10 · 2016: 6 · 2015: 6
- FWCI
- 6.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Parkinsonism & Related Disorders (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- Parkinson's disease
- MeSH terms
- Adult, Aged, Aged, 80 and over, Autonomic Nervous System Diseases, Blood Pressure, Diagnosis, Differential, Female, Heart Rate, Humans, Male, Middle Aged, Parkinson Disease, Retrospective Studies, Valsalva Maneuver, Discriminant Analysis, Tilt-Table Test, Multiple System Atrophy, Early Diagnosis
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