Validation of the Neurogenic Orthostatic Hypotension Ratio with Active Standing

Fanciulli, Alessandra; Kerer, Katharina; Leys, Fabian; Seppi, Klaus; Kaufmann, Horacio; Norcliffe‐Kaufmann, Lucy; Wenning, Gregor K.

doi:10.1002/ana.25834

Cited by 33 publications

(23 citation statements)

References 7 publications

(1 reference statement)

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“…Beyond the differential diagnostic implications arising from the presence of cardiovascular autonomic failure, the establishment of an appropriate therapeutic regimen is of utmost importance in order to reduce the symptomatic burden and avoid short and long-term complications of untreated BP dysregulation [93]. Screening for neurogenic OH at bedside with simple supine to standing HR and BP measurements [101,102] and confirmation of the diagnosis with CAFT should therefore always be considered if cardiovascular autonomic failure is suspected.…”

Section: Discussionmentioning

confidence: 99%

The role of cardiovascular autonomic failure in the differential diagnosis of α-synucleinopathies

2021

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The α-synucleinopathies comprise a group of adult-onset neurodegenerative disorders including Parkinson’s disease (PD), multiple system atrophy (MSA), dementia with Lewy bodies (DLB,) and — as a restricted non-motor form — pure autonomic failure (PAF). Neuropathologically, the α-synucleinopathies are characterized by aggregates of misfolded α-synuclein in the central and peripheral nervous system. Cardiovascular autonomic failure is a common non-motor symptom in people with PD, a key diagnostic criterion in MSA, a supportive feature for the diagnosis of DLB and disease-defining in PAF. The site of autonomic nervous system lesion differs between the α-synucleinopathies, with a predominantly central lesion pattern in MSA versus a peripheral one in PD, DLB, and PAF. In clinical practice, overlapping autonomic features often challenge the differential diagnosis among the α-synucleinopathies, but also distinguish them from related disorders, such as the tauopathies or other neurodegenerative ataxias. In this review, we discuss the differential diagnostic yield of cardiovascular autonomic failure in individuals presenting with isolated autonomic failure, parkinsonism, cognitive impairment, or cerebellar ataxia.

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Section: Discussionmentioning

confidence: 99%

The role of cardiovascular autonomic failure in the differential diagnosis of α-synucleinopathies

2021

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“…Orthostatic hypotension was diagnosed according to the consensus statement defining OH as a systolic blood pressure (BP) drop of at least 20 mmHg and/or a reduction in diastolic blood pressure of at least 10 mmHg at 3 min tilting or active standing [36]. Neurogenic orthostatic hypotension (nOH) was defined by a ratio < 0.5 of the increase in heart rate divided by the decrease in systolic blood pressure during tilt-table examination [37,38]. Prior to the test, patients were asked to avoid coffee, tea or taurine-containing beverages and have their last meals 2 h before the scheduled test.…”

Section: Cardiovascular Autonomic Functionmentioning

confidence: 99%

Cardiac sympathetic innervation in Parkinson’s disease versus multiple system atrophy

et al. 2022

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Purpose The aims of this study were to evaluate the diagnostic accuracy of the dual imaging method combining cardiac iodine-123-metaiodobenzylguanidine single-photon emission computed tomography combined with low-dose chest computed tomography compared to routine cardiac scintigraphy, and assess regional differences in tracer distribution and the relationships between imaging and autonomic function in Parkinson’s disease and multiple system atrophy. Methods A prospective study including 19 Parkinson’s disease and 12 multiple system atrophy patients was performed. Patients underwent clinical evaluation, iodine-123-metaiodobenzylguanidine single-photon emission computed tomography combined with chest computed tomography, planar scintigraphy, and cardiovascular autonomic function tests. Results Co-registration of single-photon emission computed tomography and chest computed tomography resulted in three groups with distinct patterns of tracer uptake: homogeneous, non-homogeneously reduced and absent. There was a significant difference in group allocation among patients with multiple system atrophy and Parkinson’s disease (p = 0.001). Most multiple system atrophy patients showed homogeneous uptake, and the majority of Parkinson’s disease patients showed absent cardiac tracer uptake. We identified a pattern of heterogeneous cardiac tracer uptake in both diseases with reductions in the apex and the lateral myocardial wall. Sympathetic dysfunction reflected by a missing blood pressure overshoot during Valsalva manoeuvre correlated with cardiac tracer distribution in Parkinson’s disease patients (p < 0.001). Conclusions The diagnostic accuracy of the dual imaging method and routine cardiac scintigraphy were similar. Anatomical tracer allocation provided by the dual imaging method of cardiac iodine-123-metaiodobenzylguanidine single-photon emission computed tomography and chest computed tomography identified a heterogeneous subgroup of Parkinson’s disease and multiple system atrophy patients with reduced cardiac tracer uptake in the apex and the lateral wall. Sympathetic dysfunction correlated with cardiac imaging in Parkinson’s disease patients.

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“…An appropriate HR response is defi ned by the ratio of the change in HR to the change in systolic BP with head-up tilt or About 50% of venous pooling is in the thighs, 25% in the lower legs, and 25% in the pelvis standing. 5,6 In patients with intact autonomic responses, this ratio is greater than 0.5: for example, if the systolic BP falls by 40 mm Hg, a normal HR response should be an increase of greater than 20 beats per minute. 6 A ratio less than 0.5 identifi es a neurogenic component with good sensitivity (91%) and specifi city (88%).…”

Section: Is There An Appropriate Heart Rate Response?mentioning

confidence: 99%

Evaluation and management of orthostatic hypotension: Limited data, limitless opportunity

Peixoto

2022

CCJM

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Validation of the Neurogenic Orthostatic Hypotension Ratio with Active Standing

Cited by 33 publications

References 7 publications

The role of cardiovascular autonomic failure in the differential diagnosis of α-synucleinopathies

The role of cardiovascular autonomic failure in the differential diagnosis of α-synucleinopathies

Cardiac sympathetic innervation in Parkinson’s disease versus multiple system atrophy

Evaluation and management of orthostatic hypotension: Limited data, limitless opportunity

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