Non-linear Analysis of Heart Rate Variability Improves Differential Diagnosis between Parkinson Disease and Multiple System Atrophy.
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Date
2015
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Abstract
Aims: Parkinson's disease (PD) and multiple system atrophy (MSA) are neurodegenerative
disorders characterized by motor "parkinsonian" symptoms and non-motor symptoms related to
autonomic nervous system (ANS) dysfunction. The latter can be quantified with the analysis of
Heart Rate Variability (HRVa) and of its complexity. In this study nonlinear (NL) HRV complexity
parameters were calculated to assess their predictive accuracy as markers of “disease” useful for
early differentiation between PD and MSA in parkinsonian syndromes of uncertain diagnosis.
Study Design: Observational study.
Place and Duration of Study: Clinical Physiology-Biomagnetism Center, Policlinico A. Gemelli,
Rome Italy. Patients enrolled from January 2010 to October 2013.
Methodology: 51 patients [25 with “certain” diagnosis of PD, 9 with a “highly probable” diagnosis
of MSA and 17 with parkinsonian syndromes of uncertain neurological definition (6 with “undefined parkinsonism” and 11 with “suspected MSA”)] and 40 age-matched healthy control subjects were
studied. Short-term NL HRVa was performed during daily activity and during REM/NREM sleep
from 24 h ECG recordings. Discriminant analysis (DA) was used to identify which NL HRV
parameters (or their combination) were efficient to differentiate between PD and MSA in cases of
uncertain diagnosis.
Results: Compared with healthy controls, most NL HRV parameters were significantly altered in
patients (p<0.05), during both active and passive awakeness and during sleep. Most evident HRV
abnormalities were found during active awakeness in MSA. DA of recurrence plot parameters
provided the best predictive accuracy (76.5%) for the classification of parkinsonian patients with
uncertain diagnosis.
Conclusion: NL HRVa is efficient in differentiating MSA from PD and may improve earlier
diagnosis in patients with parkinsonian symptoms of uncertain nature, useful to address second
level diagnostic steps and to guide more individualized drug treatment.
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Keywords
Autonomic nervous system, Parkinson disease, multiple system atrophy, non linear HRV analysis, discriminant analysis
Citation
Brisinda Donatella, Fioravanti Francesco, Iantorno Emilia, Sorbo Anna Rita, Venuti Angela, Cataldi Claudia, Efremov Kristian, Fenici Riccardo. Non-linear Analysis of Heart Rate Variability Improves Differential Diagnosis between Parkinson Disease and Multiple System Atrophy. Cardiology and Angiology An International Journal. 2015; 4(1): 25-36.