Effectiveness of Different Methods for Baroreflex Sensitivity Assessment in Determining the Severity of Cardiovascular Autonomic Neuropathy in Patients With Parkinson's Disease.

Chih-Cheng Huang,Yun-Ru Lai,Cheng-Hsien Lu,Chia-Te Kung,Chia-Yi Lien,Ben-Chung Cheng,Yi-Fang Chiang

doi:10.3389/fnins.2022.833344

Abstract

BackgroundAutonomic disorders are an important non-motor feature of Parkinson’s disease (PD). Baroreflex sensitivity (BRS) is often used as an indicator of cardiovascular autonomic function, and it is clinically significant. Several different methods of BRS assessment have been described. We evaluated and compared the efficiency of several methods of BRS assessment for additional insight into the underlying physiology and the determination of its severity in patients with PD.Materials and MethodsEighty-five patients with PD underwent cardiovascular autonomic testing. The Composite Autonomic Scoring Scale (CASS) was used to grade the severity of autonomic impairment and to define the presence of cardiovascular autonomic neuropathy (CAN). BRS was assessed using the Valsalva maneuver (BRS_VM). In addition, spontaneous BRS was computed using the sequence method and the spectral method.Results and ConclusionThere was considerable agreement between the different methods of BRS assessment. Nevertheless, BRS_VM exhibited a higher degree of correlation with cardiovascular autonomic function than spontaneous BRS indexes obtained by the sequence or spectral method. BRS_VM, rather than spontaneous BRS, also had a predictive value for the presence of CAN to the diagnostic criteria by CASS in patients with PD.

Highlights

Autonomic disorders have been recognized as an important non-motor feature of Parkinson’s disease (PD) (MartinezMartin et al, 2011; Kim et al, 2014)
Of the 85 patients, ten exhibited suboptimal effort in the performance of Valsalva maneuver (VM), which prevented the computation of a valid Composite Autonomic Scoring Scale (CASS) score
Despite the remarkable agreement between the different methods for baroreflex sensitivity (BRS) assessment, BRS_VM had stronger correlation with CASS, which represents the severity of autonomic impairment, compared to spontaneous BRS indexes

Summary

Introduction

Autonomic disorders have been recognized as an important non-motor feature of Parkinson’s disease (PD) (MartinezMartin et al, 2011; Kim et al, 2014). Several studies have demonstrated that patients with PD exhibit decreased baroreflex sensitivity (BRS) (Szili-Torok et al, 2001; Blaho et al, 2017). In patients with severe autonomic failure, adrenergic impairment and decreased BRS cause orthostatic hypotension, which has a considerable impact on the patient’s quality of life. The decreased BRS noted in patients with PD may be a contributing factor for the increased cardiovascular risk. Autonomic disorders are an important non-motor feature of Parkinson’s disease (PD).

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Results

Conclusion