Assessment of autonomic dysfunction in Parkinson patients by electrocardiogram / Parkinson hastalarında otonomik disfonksiyonun EKG ile değerlendirilmesi

Abstract

Introduction and Objective: In Parkinson’s disease, autonomic involvement may be seen depending on degeneration of spinal autonom neuron or side effects of treatment, as well as cardinal signs. Sudden death caused by autonomic dysfunction detected by QT interval has been reported in studies. In our study; we aim to investigate the degree of QT interval prolongation, and its relationship between gender, duration of disease, and treatment in patients with Parkinson disease to evaluate autonomic dysfunction. Material and Method: Twenty patients with Parkinson’s disease followed by the Movement Disorder Outpatient Clinic in the 2nd Neurology Department, at Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery were selected. Furthermore, 18 healthy controls were included in our study. None of the participants had cardiac disease, diabetes, hypertension, electrolyte imbalance, chronic liver and kidney diseases. They were not using any drug effecting QT interval. In electocardiography (ECG) analyses, because previous RR interval affected QT interval, QT-c intervals calculated according to Bazett’s formula [QTc = QT/(RR½)] were predicated. QT, QT-c and R-R intervals were measured automatically by ECG machines. Results: Twelve (60%) of patients were female and 8 (40%) patients were male. In the control group, there were 6 (33.3%) female and 12 (66.7%) male. The mean age was 69.8 (±8.57) and 64.8 (±8.71) in the patient and control groups, respectively. The mean duration of disease was 6.1 (±3.1) years. QT, QT-c and RR intervals were not significantly correlated with duration of the disease. According to gender, Qt, QTc and RR intervals were compared in both groups, and there was not significant correlation. Means of QT-c interval were found very significantly longer in patients than controls, and means of QT interval were again found significantly longer in the patients. The RR intervals were measured in both groups and no significant correlation was found. The patients were using L-Dopa, Dopa agonist, MAO-B inhibitory drugs in similar doses and combinations, and the effects of the drugs on QT intervals could not have been compared. Among the study groups, means of QT and QTc intervals were compared and they were found substantially longer in patients. Conclusion: In Parkinson’s disease, alternations of QTc have an important role on cardioselective factors like pathologies of sympathetic and intrinsic neurons. For this reason, we think that QT-c measurement is an important parameter in terms of determining the risk of sudden death in Parkinson patients whose autonomic symptoms are prominent, and if there is a QT-c interval prolongation, these Parkinson patients must be followed by cardiologists as well.