Abstract Details

Title Withering Hearts: Spectrum of Cardiovascular Autonomic Dysfunction and 24hour Blood Pressure Variability in Early Idiopathic Parkinson’s Disease

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-044

Objective 1. To compare cardiovascular autonomic function tests (CAFT) in Idiopathic Parkinson’s Disease (IPD) patients with age-matched controls 2. To study circadian blood pressure variability (BPV) patterns using 24hour ambulatory BP monitoring (ABPM) in IPD.

Background Uncertainty prevails regarding the patterns of autonomic dysfunction in patients with IPD.

Design/Methods Patients with IPD were enrolled from December 2016 till August 2018, in Neurology department of Christian Medical College, Ludhiana. Stage (Hoehn and Yahr staging H&Y), severity (Unified Parkinson’s Disease Rating Scale UPDRS), duration of disease and symptomatic orthostatic hypotension (OH) were documented. Patients and age-matched controls underwent CAFT in the autonomic laboratory. Heart rate (HR) response to deep breathing (HRDB), HR and BP changes in Valsalva manoeuvre (VM) and automated tilt-up was assessed. Patients also underwent 24hour ABPM. The diurnal systolic blood pressure (SBP) differences were used to classify into dippers (10-20%), non-dippers (0–10%), reverse dippers (<0%) and extreme dippers (>20%).

Results There were 45 IPD patients and 40 healthy subjects. Mean age was 59±10.2 years in IPD and 59±11.7 years in controls (p=0.835). The mean duration of symptoms was 2 (1-3) years, H&Y (2±0.77) and UPDRS (32.4 ±22.2). Dysautonomia was observed in 41 (91%) of IPD patients. Following parameters were impaired in IPD as compared to controls: mean HRDB 10.5 vs 15.7 beats per minute (bpm), p=0.001; late phase 2 (7.5 vs 10.2, p=0.012), phase 4 (3.2 vs 14.0, p=0.001) and mean Valsalva ratio 1.31 vs 1.50, p<0.001 in VM. SBP fall of >20mm Hg on tilt-up was present in 23 (51%) patients. Only 14 (61%) were symptomatic and they had higher non-motor UPDRS (p=0.015). Reverse dipping pattern 22 (48.9%) was frequent than other patterns: non-dippers 11 (24.4%), dippers 8 (17.8%) and extreme dippers 4 (8.9%).

Conclusions Sympathetic and parasympathetic dysfunction is seen early in IPD. Reverse dippers were higher in this cohort.

Authors/Disclosures
Ivy Sebastian, DM (St. Stephen's Hospital) PRESENTER	No disclosure on file
	No disclosure on file
Himani Khatter (Christian Medical College)	Ms. Khatter has nothing to disclose.
	No disclosure on file
Jeyaraj D. Pandian, MD, DM (Christian Medical College)	Dr. Pandian has nothing to disclose.

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