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 19 MSA patients who underwent 24 h AMBP. We found higher nocturnal HR (nHR) (71.5 beats/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.
authors.affiliation: Department of Parkinson's Disease and Movement Disorders, IRCCS San Camillo, Venice-Lido, Italy. Electronic address: manupill@yahoo.it.
authors.forename: Manuela
authors.initials: M
authors.lastname: Pilleri
authors.affiliation: Department of Cardiology, IRCCS San Camillo, Venice, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Levedianos
authors.affiliation: Department of Parkinson's Disease and Movement Disorders, IRCCS San Camillo, Venice-Lido, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Weis
authors.affiliation: Department of Rehabilitation of Cerebral Lesions, IRCCS San Camillo, Venice, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Gasparoli
authors.affiliation: Department of Parkinson's Disease and Movement Disorders, IRCCS San Camillo, Venice-Lido, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Facchini
authors.affiliation: Department of Parkinson's Disease and Movement Disorders, IRCCS San Camillo, Venice-Lido, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Biundo
authors.affiliation: Department of Parkinson's Disease and Movement Disorders, IRCCS San Camillo, Venice-Lido, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Formento-Dojot
authors.affiliation: Department of Parkinson's Disease and Movement Disorders, IRCCS San Camillo, Venice-Lido, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Antonini
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001341:Autonomic Nervous System / Q000503:physiopathology; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000175:diagnosis* / Q000503:physiopathology; D010300:Parkinson Disease / Q000175:diagnosis* / Q000503:physiopathology; D012372:ROC Curve
keywords: Cardiovascular function; Differential diagnosis; Dysautonomia; Heart rate; Multiple system atrophy; Parkinson disease