Screening indexes for cardiovascular autonomic failure in Parkinson's disease

• Published in: Journal of the neurological sciences Vol. 428; p. 117571
• Main Authors: Vallelonga, F., Sobrero, G., Giudici, M., Valente, M., Milazzo, V., Di Stefano, C., Maule, S.
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 15.09.2021
• Subjects: Ambulatory blood pressure monitoring; Cardiovascular autonomic failure; Orthostatic hypotension; Parkinson's disease; Parkinson's disease; Cardiovascular autonomic failure; Orthostatic hypotension; Ambulatory blood pressure monitoring
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2021.117571

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.