J Clin Neurol.  2016 Apr;12(2):218-223. 10.3988/jcn.2016.12.2.218.

Cardiovagal Baroreflex Sensitivity in Parkinson's Disease and Multiple-System Atrophy

• Roy S
• Jaryal AK
• Srivastava AK
• Deepak KK

• KMID: 2354143
• DOI: http://doi.org/10.3988/jcn.2016.12.2.218

Abstract

BACKGROUND AND PURPOSE
Parkinson's disease (PD) and multiple-system atrophy of the parkinsonian type (MSA-P) are progressive neurodegenerative disorders that in addition to dysfunction of the motor system also present with features of dysautonomia, frequently manifesting as orthostatic hypotension (OH). The pathophysiology of OH has been proposed to differ between these two disorders. This study investigated the spontaneous and cardiovagal baroreflex sensitivity (BRS) in Parkinson's disease patients with orthostatic hypotension (PD(OH)) and multiple system atrophy of Parkinsonian type with orthostatic hypotension in an attempt to differentiate the two disorders.
METHODS
Two methods were used for determining the BRS: a spontaneous method (spontaneous BRS) and the reflexive baroreflex gain (cardiovagal BRS) from phases II and IV of the Valsalva maneuver (VM) in PD(OH) and MSA-P(OH).
RESULTS
The spontaneous BRS (5.04±0.66 ms/mm Hg vs. 4.78±0.64 ms/mm Hg, p=0.54) and the cardiovagal BRS from phase II of the VM (0.96±0.75 ms/mm Hg vs. 1.34±1.51 ms/mm Hg, p=0.76) did not differ between PD(OH) and MSA-P(OH), but the cardiovagal BRS from phase IV of the VM (0.03±0.07 ms/mm Hg vs. 2.86±2.39 ms/mm Hg, p=0.004) was significantly lower in PD(OH).
CONCLUSIONS
The cardiovagal BRS from phase IV of the VM has potential for differentiating PD(OH) and MSA-P(OH), indicating a difference in the pathophysiological mechanisms underlying the autonomic dysfunction in the two disorders.

Keyword

baroreflex sensitivity; valsalva maneuver; Parkinson's disease; multiple system atrophy

MeSH Terms

Atrophy*
Baroreflex*
Humans
Hypotension, Orthostatic
Multiple System Atrophy
Neurodegenerative Diseases
Parkinson Disease*
Primary Dysautonomias
Reflex
Valsalva Maneuver

Figure

• 

  Fig. 1 BRSS in PDOH and MSA-POH (5.04±0.66 ms/mm Hg vs. 4.78±0.64 ms/mm Hg; p value=0.54) was not different in the two disorders (A) but BRSVM-PIV from phase IV of VM in PDOH was significantly lesser than MSA-POH (0.03±0.07 ms/mm Hg vs. 2.86±2.39 ms/mm Hg; p value=0.004) (B) even though the BRSVM-PII from phase II of VM was not different in PDOH and MSA-POH (0.96±0.75 ms/mm Hg vs. 1.34±1.51 ms/mm Hg; p value= 0.76) (C). BRSS: spontaneous baroreflex sensitivity, BRSVM-PII: baroreflex sensitivity from phase II of Valsalva, BRSVM-PIV: baroreflex sensitivity from phase IV of Valsalva, MSA-POH: multiple-system atrophy of the Parkinsonian type with orthostatic hypotension, PDOH: Parkinson's disease patients with orthostatic hypotension.

• 

  Fig. 2 LF and HF indices of the heart rate variability in PDOH and MSA-POH are not different between the two disorders (1.78±0.21 ms2 vs. 1.67±0.14 ms2; p value=0.66 and 1.45±0.18 ms2 vs. 1.64±0.17 ms2; p value=0.47 respectively) (A and B) and the LF/HF ratio shows a higher trend in PDOH as compared to MSA-POH (2.36±1.06 vs. 1.77±1.97; p value=0.05) (C). HF: high frequency, HRV: heart rate variability, LF: low frequency, MSA-POH: multiple-system atrophy of the parkinsonian type, PDOH: Parkinson's disease patients with orthostatic hypotension.

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