title: Cardiovascular dysfunction in untreated Parkinson's disease: A multi-modality assessment.
abstract: BACKGROUND
  The clinical presentation of Parkinson's disease (PD) includes a wide spectrum of non-motor features, including cardiovascular autonomic failure.
  
  
  OBJECTIVE
  To evaluate cardiovascular autonomic status and cardiac functional capacity in drug-naïve PD patients.
  
  
  METHODS
  18 newly-diagnosed PD patients underwent laboratory cardiovascular autonomic function tests using power spectral analysis of the R-R interval, blood pressure (BP) short-term variability and non-invasive baroreflex sensitivity (BRS). A two-dimensional (2D) transthoracic echocardiogram, spirometry and cardiopulmonary exercise test (CPET) were also performed. Thirteen patients underwent myocardial scintigraphy with [123I] metaiodobenzylguanidine (MIBG).
  
  
  RESULTS
  At rest, total power spectral analysis of heart rate variability was lower in PD patients than in controls. BRS decreased during sympathetic activation in both patients and controls. While echocardiography and spirometry were normal, a mild degree of exercise intolerance was observed at the CPET in PD patients (mean V'O2max: 83% of predicted; mean Wmax: 80% of predicted). The heart-to-mediastinum (H/M) ratio of MIBG uptake was pathologically impaired in 9 patients, one of whom displayed a definite cardiovascular dysautonomic pattern.
  
  
  CONCLUSIONS
  Our results confirm that subclinical to overt cardiovascular autonomic failure may occur from the early stages of PD. The less efficient adaptive response to physical stimuli during the CPET and postural changes observed in untreated PD patients possibly reflect cardiac sympathetic denervation, although the involvement of PD-related motor impairment in physical deconditioning cannot be excluded.
authors: Department of Heart and Great Vessels "A. Reale", Sapienza University of Rome, Italy.
authors: Stefano
authors: S
authors: Strano
authors: Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Italy; Department of Neurology, Innsbruck Medical University, Austria.
authors: Alessandra
authors: A
authors: Fanciulli
authors: Department of Heart and Great Vessels "A. Reale", Sapienza University of Rome, Italy.
authors: Massimiliano
authors: M
authors: Rizzo
authors: Department of Public Health and Infectious Disease, Sapienza University of Rome, Italy.
authors: Paolo
authors: P
authors: Marinelli
authors: Department of Public Health and Infectious Disease, Sapienza University of Rome, Italy.
authors: Paolo
authors: P
authors: Palange
authors: Department of Cell Biology and Neurosciences, Italian Institute of Health, Rome, Italy.
authors: Dorina
authors: D
authors: Tiple
authors: Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy.
authors: Giuseppe
authors: G
authors: De Vincentis
authors: Department of Technology and Health, Italian Institute of Health, Rome, Italy.
authors: Giovanni
authors: G
authors: Calcagnini
authors: Department of Technology and Health, Italian Institute of Health, Rome, Italy.
authors: Federica
authors: F
authors: Censi
authors: Department of Neurology and Psychiatry and Research Centre of Social Diseases (CIMS), Sapienza University of Rome, Italy.
authors: Giuseppe
authors: G
authors: Meco
authors: Department of Neurology, Santa Maria University Hospital, Terni, Italy. Electronic address: carlo.colosimo@uniroma1.it.
authors: Carlo
authors: C
authors: Colosimo
mesh_terms: D019797:3-Iodobenzylguanidine; D017704:Baroreflex; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D019275:Radiopharmaceuticals; D013147:Spirometry
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine
keywords: Cardiopulmonary exercise test; Cardiovascular autonomic failure; Non-motor symptoms; Orthostatic hypotension; Parkinson's disease