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Assessment of cardiovascular autonomic dysfunction in multiple system atrophy

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Abstract

Because heart rate is controlled mainly by the autonomic nervous system, cardiovascular autonimic dysfunction may contribute to the prognosis of patients with multiple system atrophy (MSA). To clarify cardiovascular autonomic dysfunctions in MSA, the authors investigated the relation between blood pressure (BP) and pulse rate (PR), and assessed a power spectral analysis of heart rate variability (HRV) during the clinical course using ambulatory BP and a heart rate monitor for 24 hours. The authors studied seven patients with MSA (five men and two women, aged 61.0±5.8 years) and seven healthy volunteers (four men and three women, aged 58.0±6.6 years) without hypertension, heart disease, or intracranial lesions. The MSA group showed abnormal circadian variations of BP and PR and a significantly decreased correlation coefficient between BP and PR. A significant decrease and altered circadian variation also existed in the number of changes in successive R-R intervals greater than 50 msec (RR50) and in the power of the high- and low-frequency component of HRV. The authors observed a significant negative correlation between the duration of illness and the number of changes in successive R-R intervals greater than 50 msec. The characteristic dysautonomia in MSA was a decrease in sympathetic and parasympathetic activity, with an abnormal circadian rhythm of BP and HRV. The balance between sympathetic and parasympathetic activity was also impaired. The parasympathetic modulation represented by RR50 worsened according to the development of the illness. Those autonomic dysfunctions may have affected the cardiovascular systems, which may indicate a poor prognosis in patients with MSA. An analysis of HRV and the circadian rhythm of BP and HRV are useful in evaluating cardiac autonomic dysfunctions in MSA.

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References

  1. Gilman S, Low P, Quinn P, et al. Consensus statement on the diagnosis of multiple system atrophy.Clin Auton Res 1998; 8:359–362.

    CAS  PubMed  Google Scholar 

  2. Levy MN, Zieske H. Autonomic control of cardiac pacemaker activity and atrioventricular transmission.J Appl Physiol 1969; 27:465–470.

    CAS  PubMed  Google Scholar 

  3. Vatner SF, Higgins CB, Braunwald E. Sympathetic and parasympathetic components of reflex tachycardia induced by hypotension in conscious dogs with and without heart failure.Cardiovasc Res 1974; 8:153–161.

    CAS  PubMed  Google Scholar 

  4. Pomeranz B, MaCaulay RJB, Caudill MA, et al. Assessment of autonomic function in humans by heart rate spectral analysis.Am J Physiol 1985; 248:H151-H153.

    CAS  PubMed  Google Scholar 

  5. Pastakia B, Polinsky R, DiChiro G, et al. Multiple system atrophy (Shy-Drager syndrome): MR imaging.Radiology 1986; 159:499–502.

    CAS  PubMed  Google Scholar 

  6. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation, and clinical use.Circulation 1996; 93:1043–1065.

    Google Scholar 

  7. Pickering TG. The clinical significance of diurnal blood pressure variations: dippers and nondippers.Circulation 1990; 81:700–702.

    CAS  PubMed  Google Scholar 

  8. Littler WA, Hornour AJ, Carter RD, et al. Sleep and blood pressure.BMJ 1975; 3:346–348.

    CAS  PubMed  Google Scholar 

  9. Tochikubo O, Miyazaki N, Kaneko Y. Relationship between 24-hour arterial pressure and heart rate variation in normotensives, hypertensives and patients with Shy-Drager syndrome.Jpn Circ J 1987; 51:485–494.

    CAS  PubMed  Google Scholar 

  10. Shimada K, Kawamoto A, Matsubayashi K, et al. Silent cerebrovascular disease in the elderly: correlation with ambulatory pressure.Hypertension 1990; 16:692–699.

    CAS  PubMed  Google Scholar 

  11. Murata Y, Harada T, Ishizaki F, et al. Autonomic dysfunction in Parkinson's disease and vascular parkinsonism.Acta Neurol Scand 1997; 96:359–365.

    CAS  PubMed  Google Scholar 

  12. Harada T, Nakamura S. Diurnal blood pressure variation in Parkinson's disease and vascular parkinsonism [in Japanese; English abstract].Neurol Med (Tokyo) 1991; 33:108–114.

    Google Scholar 

  13. Wieling W. Standing, orthostatic stress and autonomic function. In:Autonomic failure, a textbook of clinical disorders of the autonomic nervous system, 2nd ed., Bannister R, ed. Oxford: Oxford University Press; 1988. pp. 308–320.

    Google Scholar 

  14. Carvalho MJ, van Den Meiracker AH, Boomsma F, et al. Diurnal blood pressure variation in progressive autonomic failure.Hypertension 2000; 35:892–897.

    CAS  PubMed  Google Scholar 

  15. Goldstein DS, Holmes C, Li ST, et al. Cardiac sympathetic denervation in Parkinson disease.Ann Intern Med 2000; 133:338–347.

    CAS  PubMed  Google Scholar 

  16. Odajima N, Matsunaga T, Furukawa T, et al. Circadian rhythm of blood pressure and pulse rate in spinal cord injury and peripheral neuropathy [in Japanese; English abstract].Auton Nerv Syst (Tokyo) 1989; 26:134–140.

    Google Scholar 

  17. Murata Y, Harada T, Ishizaki F, et al. An abnormal relationship between blood pressure and pulse rate in amyotrophic lateral sclerosis.Acta Neurol Scand 1997; 96:118–122.

    CAS  PubMed  Google Scholar 

  18. Riku S, Senda Y, Takahashi A. Blood pressure and prognosis in the Shy-Drager syndrome. [in Japanese; English abstract].Auton Nerv Syst (Tokyo) 1988; 25:370–374.

    Google Scholar 

  19. Ewing DJ, Nelson JMM, Travis P. New method for assessing cardiac parasympathetic activity using 24-hour electrocardiograms.Br Heart J 1984; 52:396–402.

    CAS  PubMed  Google Scholar 

  20. Khurana RK, Nelson E, Azzarelli B, et al. Shy-Drager syndrome: diagnosis and treatment of cholinergic dysfunction.Neurology 1980; 30:805–809.

    CAS  PubMed  Google Scholar 

  21. Pagani M, Lombardi F, Guzzetti S, et al. Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog.Circ Res 1986; 59:178–193.

    CAS  PubMed  Google Scholar 

  22. Malliani A, Pagani M, Lombardi F, et al. Cardiovascular neural regulation explored in the frequency domain.Circulation 1991; 84:482–492.

    CAS  PubMed  Google Scholar 

  23. Goldberger AL, Goldwater D, Bhargava V. Atropine unmasks bedrest effect: a spectral analysis of cardiac interbeat intervals.J Appl Physiol 1986; 61:1843–1848.

    CAS  PubMed  Google Scholar 

  24. Murata K, Landrigan PJ, Araki S. Effects of age, heart rate, gender, tobacco and alcohol ingestion on R-R interval variability in human ECG.J Auton Nerv Syst 1992; 37:199–206.

    Article  CAS  PubMed  Google Scholar 

  25. Saito Y, Matsuoka Y, Takahashi A, et al. Survival of patients with multiple system atrophy.Intern Med 1994; 33:321–325.

    CAS  PubMed  Google Scholar 

  26. Testa D, Filippini G, Farinotti M, et al. Survival in multiple system atrophy: a study of prognostic factors in 59 cases.J Neurol 1996; 243:401–404.

    Article  CAS  PubMed  Google Scholar 

  27. Ben-Shlomo Y, Wenning GK, Tison F, et al. Survival of patients with pathologically proven multiple system atrophy: a meta-analysis.Neurology 1997; 48:384–393.

    CAS  PubMed  Google Scholar 

  28. Munschauer FE, Loh L, Bannister R, et al. Abnormal respiration and sudden death during sleep in multiple system atrophy with autonomic failure.Neurology 1990; 40:677–679.

    CAS  PubMed  Google Scholar 

  29. Williams A, Hansos D, Calne DB. Vocal cord paralysis in the Shy-Drager syndrome.J Neurol Neurosurg Psychiatry 1979; 42:151–153.

    CAS  PubMed  Google Scholar 

  30. Inoue K, Ogata H, Matsui M, et al. Assessment of autonomic function in myotonic dystrophy by spectral analysis of heart-rate variability.J Auton Nerv Syst 1995; 55:131–134.

    Article  CAS  PubMed  Google Scholar 

  31. Spinnler MT, Lombardi F, Moretti C, et al. Evidence of functional alterations in sympathetic activity after myocardial infarction.Eur Heart J 1993; 14:1334–1343.

    CAS  PubMed  Google Scholar 

  32. van Ravenswaaij-Arts CMA, Kollee LAA, Hopman JCW, et al. Heart rate variability.Ann Intern Med 1993; 118:436–447.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Third Department of Internal Medicine, Hiroshima University School of Medicine, 1-2-3 Kasumi, 734-8551, Minami-ku, Hiroshima, Japan

    Shihori Kitae M.D., Noriko Tachiki M.D., Masanori Okazaki M.D., Toshihide Harada Ph.D. & Shigenobu Nakamura Ph.D.

  2. Department of Internal Medicine, National Yanai Hospital, Yanai, Japan

    Yoshio Murata Ph.D.

Authors
  1. Shihori Kitae M.D.
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  2. Yoshio Murata Ph.D.
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  3. Noriko Tachiki M.D.
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  4. Masanori Okazaki M.D.
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  5. Toshihide Harada Ph.D.
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  6. Shigenobu Nakamura Ph.D.
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Correspondence to Shihori Kitae M.D..

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Kitae, S., Murata, Y., Tachiki, N. et al. Assessment of cardiovascular autonomic dysfunction in multiple system atrophy. Clinical Autonomic Research 11, 39–44 (2001). https://doi.org/10.1007/BF02317801

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  • DOI: https://doi.org/10.1007/BF02317801

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