1
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Su D, Zhang X, Su Y, Chan P, Xu E. Effects of different levodopa doses on blood pressure in older patients with early and middle stages of Parkinson's disease. Heliyon 2023; 9:e17876. [PMID: 37483692 PMCID: PMC10362309 DOI: 10.1016/j.heliyon.2023.e17876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 05/03/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Levodopa is the first-line treatment for patients with Parkinson's disease (PD). However, only a few studies have focused on the tolerance of this drug in older patients with PD in the early and middle stages. Therefore, this study aimed to explore the effects of different levodopa doses on blood pressure (BP) in this subpopulation. Methods This cohort analysis enrolled 83 patients. The levodopa challenge test was used to evaluate drug responsiveness. After at least 12 h following anti-PD drug discontinuation, patients' BPs were measured in a lying position, after 1 min standing, and after 3 min standing, in "off state" and best "on state." Results BP in the 250 mg and 375 mg levodopa/benserazide groups decreased significantly in the lying and standing positions. The 3-min standing-position systolic BP was significantly influenced by the dose of levodopa/benserazide. However, no statistical change was observed in the 125 mg group. The postural-mediated systolic BP disparity was significant at 3 min in the upright position. Nineteen (incidence, 22.9%) and Twenty-five patients (incidence, 30.1%) developed complications of orthostatic hypotension (OH) in the "off state" and best "on state," respectively. Mild cognitive impairment was a risk factor for OH occurrence in the "off state." The OH occurrence in the best "on state" was associated with OH in the "off state" and urinary incontinence. Conclusion Our findings suggest that 250 mg or more of levodopa/benserazide could significantly reduce BP and orthostatic effect in older patients with PD in the early and middle stages. Therefore, they should routinely monitor their BP. Trial registration number ChiCTR2200055707.
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Affiliation(s)
- Dan Su
- Department of Geriatrics, Liangxiang Hospital of Beijing Fangshan District, Beijing 102400, China
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Xiaojun Zhang
- Department of Geriatrics, Occupational Disease Prevention and Control Institute of Chemical Industry, Beijing 100093, China
| | - Yanling Su
- Department of Geriatrics, Liangxiang Hospital of Beijing Fangshan District, Beijing 102400, China
| | - Piu Chan
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
- Clinical Center for Parkinson's Disease, Parkinson Disease Center of Beijing Institute for Brain Disorders, Beijing 100053, China
| | - Erhe Xu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
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2
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Cereja F, Alves M, Ferreira JJ, Caldeira D. Atrial fibrillation risk on Parkinson's disease - a systematic review and meta-analysis. J Thromb Thrombolysis 2023; 55:747-750. [PMID: 36964284 DOI: 10.1007/s11239-023-02792-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/26/2023]
Abstract
The association of Parkinson's Disease (PD) with atrial fibrillation (AF) is not well established and previous studies' results were heterogeneous. This review aimed to evaluate if patients with PD are at increased risk of having AF. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science, were searched from inception May 2021. Two reviewers independently selected observational studies with data allowing to estimate the risk of atrial fibrillation in PD patients compared with no-PD controls. Pooled estimates Odds Ratio (OR) and 95% confidence intervals (CIs) were derived through meta-analysis. Heterogeneity was assessed using I2 test. The risk of bias of individual studies was evaluated using the ROBINS-I tool. The study protocol was registered at PROSPERO: CRD42020216572. Seven studies were included: five case-control studies and two cohort studies. Three of the studies included were a population-based study. No significant difference was detected between PD and controls regarding atrial fibrillation (OR 1.10, 95% CI 0.81 to 1.49). Early PD present a significant higher risk of AF (OR 1.55, 95% CI 1.00 to 2.40, I2 98%). The overall risk of bias was serious, with only two studies being considered as having moderate risk. The best evidence available do not support that there is an increased risk of AF in PD patients. Further studies are needed to better conclude if there is a relation between AF and PD.
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Affiliation(s)
- Fátima Cereja
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mariana Alves
- Serviço de Medicina III, Hospital Pulido Valente (CHULN), Lisboa, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- CNS - Campus Neurológico, Torres Vedras, Portugal
| | - Daniel Caldeira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
- Faculdade de Medicina, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), CEMBE, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa, 1649-028, Portugal.
- Serviço de Cardiologia, Hospital Universitário de Santa Maria (CHULN), Lisboa, Portugal.
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3
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Alves M, Pita Lobo P, Azevedo Kauppila L, Rebordão L, Cruz MM, Guerreiro C, Ferro JM, Ferreira JJ, Reimão S. Neuroimaging cerebrovascular biomarkers in Parkinson's disease. Neuroradiol J 2021; 35:490-496. [PMID: 34872414 PMCID: PMC9437505 DOI: 10.1177/19714009211059118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE The cardiovascular risk in Parkinson's disease (PD) remains uncertain and controversial. Some studies suggest PD patients present an increased risk of cerebrovascular disease. We aimed to study the prevalence of neuroimaging cerebrovascular biomarkers in PD patients compared to controls, using an accurate and complete magnetic resonance (MR) imaging evaluation. MATERIAL AND METHODS Neuroimaging sub-study within a larger cross-sectional case-control study. An enriched subgroup of PD patients (≤10 years since diagnosis) with at least a moderate cardiovascular mortality risk based on a Systematic COronary Risk Evaluation (SCORE) was compared to community-based controls regarding neuroimaging biomarkers. Patients underwent a high-resolution T1-weighted MR imaging sequence at 3.0 T to visualize neuromelanin. A 3D SWI FFE, sagittal 3D T1-weighted, axial FLAIR and diffusion-weighted image sequences were obtained. RESULTS The study included 47 patients, 24 with PD and 23 controls. PD patients presented a reduced area and signal intensity of the substantia nigra and locus coeruleus on neuromelanin-sensitive MR. The median SCORE was 5% in both groups. No significant differences regarding white matter hyperintensities (OR 4.84, 95% CI 0.50, 47.06), lacunes (OR 0.43, 95% CI 0.07, 2.63), microbleeds (OR 0.64, 95% CI 0.13, 3.26), or infarcts (0.95, 95% CI 0.12, 7.41) was found. The frequency of these neuroimaging biomarkers was very low in both groups. CONCLUSION The present study does not support an increased prevalence of neuroimaging cerebrovascular biomarkers in PD patients.
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Affiliation(s)
- Mariana Alves
- Serviço de Medicina III, 70896Hospital Pulido Valente (CHULN), Lisboa, Portugal.,Avenida Professor Egas Moniz, Faculty of Medicine, 89237University of Lisbon, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, 89237Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisbon, Lisbon, Portugal
| | - Patrícia Pita Lobo
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisbon, Lisbon, Portugal.,Departamento de Neurociências e Saúde Mental, CHULN, Lisbon, Portugal
| | | | | | - M Manuela Cruz
- Unidade de Saúde Familiar Benfica Jardim, 89237ACES Lisboa Norte, Lisbon, Portugal
| | - Carla Guerreiro
- Neurological Imaging Department, 89237Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal.,Imaging University Clinic, Faculdade de Medicina, 89237Universidade de Lisboa, Lisbon, Portugal
| | - José M Ferro
- Avenida Professor Egas Moniz, Faculty of Medicine, 89237University of Lisbon, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisbon, Lisbon, Portugal.,Departamento de Neurociências e Saúde Mental, CHULN, Lisbon, Portugal
| | - Joaquim J Ferreira
- Avenida Professor Egas Moniz, Faculty of Medicine, 89237University of Lisbon, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, 89237Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisbon, Lisbon, Portugal.,CNS - Campus Neurológico Sénior, Lisbon, Portugal
| | - Sofia Reimão
- Avenida Professor Egas Moniz, Faculty of Medicine, 89237University of Lisbon, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, 89237Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisbon, Lisbon, Portugal.,Neurological Imaging Department, 89237Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal.,Imaging University Clinic, Faculdade de Medicina, 89237Universidade de Lisboa, Lisbon, Portugal
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4
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Alves M, Pita Lobo P, Kauppila LA, Rebordão L, Cruz MM, Soares F, Cruz J, Tornada A, Caldeira D, Reimão S, Oliveira V, Ferro JM, Ferreira JJ. Cardiovascular and cerebrovascular risk markers in Parkinson's disease: Results from a case-control study. Eur J Neurol 2021; 28:2669-2679. [PMID: 34033182 DOI: 10.1111/ene.14938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The relationship between Parkinson's disease (PD) and cardiovascular and cerebrovascular disease is not yet well established. Recent data suggest an increased risk of myocardial infarction and stroke in PD patients. Therefore, we designed a study to assess surrogate markers of cardiovascular and cerebrovascular risk in PD. METHODS We conducted a case-control study comparing PD patients recruited from a Movement Disorders Unit with controls randomly invited from a primary healthcare center. All participants underwent a detailed clinical evaluation, including medical history, physical assessment, carotid ultrasound, blood and urine analysis, and 24-h ambulatory blood pressure monitoring. The primary outcome was the carotid intima-media thickness (CIMT). RESULTS We included 102 participants in each study arm. No significant difference was found in the CIMT among groups (MD: 0.01, 95% CI: -0.02, 0.04). Carotid plaques were more frequent in PD patients (OR: 1.90, 95% CI: 1.02, 3.55), although the lipid profile was more favorable in this group (LDL MD: -18.75; 95% CI: -10.69, -26.81). Nocturnal systolic blood pressure was significantly higher in PD patients (MD: 4.37, 95% CI: 0.27, 8.47) and more than half of the PD patients were non-dippers or reverse dippers (OR: 1.83, 95% CI: 1.04, 3.20). CONCLUSION We did not find a difference in CIMT between PD and controls. A higher frequency of carotid plaques and abnormal dipper profile supports the hypothesis that PD patients are not protected from cardiovascular and cerebrovascular disease.
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Affiliation(s)
- Mariana Alves
- Serviço de Medicina III, Hospital Pulido Valente, CHULN, Lisboa, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Patrícia Pita Lobo
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, CHULN, Lisboa, Portugal
| | - Linda Azevedo Kauppila
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, CHULN, Lisboa, Portugal
| | - Leonor Rebordão
- Serviço de Neurologia, Hospital Fernando da Fonseca, Lisboa, Portugal
| | - M Manuela Cruz
- Unidade de Saúde Familiar Benfica Jardim, ACES Lisboa Norte, Lisboa, Portugal
| | - Fátima Soares
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, CHULN, Lisboa, Portugal.,Laboratório de Hemodinâmica Cerebral, Serviço de Neurologia, CHULN, Lisboa, Portugal
| | - João Cruz
- Unidade de Técnicas de Cardiologia, Hospital Pulido Valente, CHULN, Lisboa, Portugal
| | - Ana Tornada
- Centro Cardiovascular da Universidade de Lisboa - CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Serviço Medicina I, Hospital Santa Maria, CHULN, Lisboa, Portugal
| | - Daniel Caldeira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Centro Cardiovascular da Universidade de Lisboa - CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Serviço de Cardiologia, Hospital de Santa Maria, CHULN, Lisboa, Portugal
| | - Sofia Reimão
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Neurological Imaging Department, CHULN, Lisboa, Portugal.,Imaging University Clinic, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Victor Oliveira
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, CHULN, Lisboa, Portugal.,Laboratório de Hemodinâmica Cerebral, Serviço de Neurologia, CHULN, Lisboa, Portugal
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, CHULN, Lisboa, Portugal
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
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5
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Cacabelos R, Carrera I, Martínez O, Alejo R, Fernández-Novoa L, Cacabelos P, Corzo L, Rodríguez S, Alcaraz M, Nebril L, Tellado I, Cacabelos N, Pego R, Naidoo V, Carril JC. Atremorine in Parkinson's disease: From dopaminergic neuroprotection to pharmacogenomics. Med Res Rev 2021; 41:2841-2886. [PMID: 34106485 DOI: 10.1002/med.21838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 02/11/2021] [Accepted: 05/21/2021] [Indexed: 12/15/2022]
Abstract
Atremorine is a novel bioproduct obtained by nondenaturing biotechnological processes from a genetic species of Vicia faba. Atremorine is a potent dopamine (DA) enhancer with powerful effects on the neuronal dopaminergic system, acting as a neuroprotective agent in Parkinson's disease (PD). Over 97% of PD patients respond to a single dose of Atremorine (5 g, p.o.) 1 h after administration. This response is gender-, time-, dose-, and genotype-dependent, with optimal doses ranging from 5 to 20 g/day, depending upon disease severity and concomitant medication. Drug-free patients show an increase in DA levels from 12.14 ± 0.34 pg/ml to 6463.21 ± 1306.90 pg/ml; and patients chronically treated with anti-PD drugs show an increase in DA levels from 1321.53 ± 389.94 pg/ml to 16,028.54 ± 4783.98 pg/ml, indicating that Atremorine potentiates the dopaminergic effects of conventional anti-PD drugs. Atremorine also influences the levels of other neurotransmitters (adrenaline, noradrenaline) and hormones which are regulated by DA (e.g., prolactin, PRL), with no effect on serotonin or histamine. The variability in Atremorine-induced DA response is highly attributable to pharmacogenetic factors. Polymorphic variants in pathogenic (SNCA, NUCKS1, ITGA8, GPNMB, GCH1, BCKDK, APOE, LRRK2, ACMSD), mechanistic (DRD2), metabolic (CYP2D6, CYP2C9, CYP2C19, CYP3A4/5, NAT2), transporter (ABCB1, SLC6A2, SLC6A3, SLC6A4) and pleiotropic genes (APOE) influence the DA response to Atremorine and its psychomotor and brain effects. Atremorine enhances DNA methylation and displays epigenetic activity via modulation of the pharmacoepigenetic network. Atremorine is a novel neuroprotective agent for dopaminergic neurons with potential prophylactic and therapeutic activity in PD.
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Affiliation(s)
- Ramón Cacabelos
- Department of Genomic Medicine, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Iván Carrera
- Department of Health Biotechnology, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Olaia Martínez
- Department of Medical Epigenetics, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | | | | | - Pablo Cacabelos
- Department of Digital Diagnosis, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Lola Corzo
- Department of Medical Biochemistry, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Susana Rodríguez
- Department of Medical Biochemistry, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Margarita Alcaraz
- Department of Genomic Medicine, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Laura Nebril
- Department of Genomic Medicine, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Iván Tellado
- Department of Digital Diagnosis, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Natalia Cacabelos
- Department of Medical Documentation, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Rocío Pego
- Department of Neuropsychology, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Vinogran Naidoo
- Department of Neuroscience, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Juan C Carril
- Department of Genomics & Pharmacogenomics, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
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6
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Alves M, Abrantes AM, Portugal G, Cruz MM, Reimão S, Caldeira D, Ferro JM, Ferreira JJ. Does Parkinson's Disease Increase the Risk of Atrial Fibrillation? Insights From Electrocardiogram and Risk Scores From a Case-Control Study. Front Neurol 2021; 12:633900. [PMID: 34054687 PMCID: PMC8149901 DOI: 10.3389/fneur.2021.633900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/31/2021] [Indexed: 11/27/2022] Open
Abstract
Background: Previous studies suggested that Parkinson's Disease (PD) patients could have an increased risk of atrial fibrillation. However, data supporting this association is not robust. We aimed to compare the potential risk of atrial fibrillation associated with PD in an age and gender matched case-control study, comparing the p-wave indexes from electrocardiograms and clinical risk scores among groups. Methods: A cross-sectional case-control study was performed. All subjects included in the analysis were clinically evaluated and subjected to a 12-lead electrocardiogram. Two blinded independent raters measured the p-wave duration. Subjects were classified as having normal P-wave duration (<120 ms), partial IAB (P-wave duration ≥ 120 ms, positive in inferior leads), and advanced IAB (p-wave duration ≥ 120 ms with biphasic morphology in inferior leads). Atrial fibrillation risk scores (CHARGE-AF, HATCH, and HAVOC) were calculated. Results: From 194 potential participants, three were excluded from the control group due to a previous diagnosis of atrial fibrillation. Comparing the PD patients (n = 97) with controls (n = 95), there were no statistically significant differences regarding the mean p-wave duration (121 ms vs. 122 ms, p = 0.64) and proportion of advanced interatrial block (OR = 1.4, 95%CI = 0.37–5.80, p = 0.58). All patients had a low or medium risk of developing atrial fibrillation based on the clinical scores. There were no differences between the PD patients and controls regarding the mean values of CHARGE-AF, HATCH, and HAVOC. Conclusions: Our results do not support the hypothesis that PD patients have an increased risk of atrial fibrillation based on the p-wave predictors and atrial fibrillation clinical scores.
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Affiliation(s)
- Mariana Alves
- Serviço de Medicina III, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Mafalda Abrantes
- Medicina 2, Clínica Universitária de Medicina, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
| | - Gonçalo Portugal
- Serviço de Medicina III, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
| | - M Manuela Cruz
- Unidade de Saúde Familiar (USF) Benfica Jardim, Agrupamentos de Centros de Saúde (ACES) Lisboa Norte, Lisbon, Portugal
| | - Sofia Reimão
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal.,Neurological Imaging Department, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal.,Faculdade de Medicina, Imaging University Clinic, Universidade de Lisboa, Lisbon, Portugal
| | - Daniel Caldeira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Faculdade de Medicina, Centro Cardiovascular da Universidade de Lisboa, Centro Académico de Medicina de Lisboa (CAML), Universidade de Lisboa, Lisbon, Portugal.,Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
| | - José M Ferro
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal.,Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal.,Campus Neurológico Sénior, Torres Vedras, Portugal
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7
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Alves M, Caldeira D, Ferro JM, Ferreira JJ. Reply to the letter ‘We never speak about sudden unexpected death in Parkinson’s disease’. Eur J Neurol 2020; 27:e29. [DOI: 10.1111/ene.14216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 11/29/2022]
Affiliation(s)
- M. Alves
- Serviço de Medicina III Hospital Pulido Valente CHULN LisboaPortugal
- Laboratory of Clinical Pharmacology and Therapeutics Faculdade de Medicina Universidade de Lisboa Lisboa Portugal
- Instituto de Medicina Molecular Faculdade de Medicina Universidade de Lisboa Lisboa Portugal
| | - D. Caldeira
- Laboratory of Clinical Pharmacology and Therapeutics Faculdade de Medicina Universidade de Lisboa Lisboa Portugal
- Instituto de Medicina Molecular Faculdade de Medicina Universidade de Lisboa Lisboa Portugal
- Serviço de Cardiologia Hospital Universitário de Santa Maria CAML Centro Cardiovascular da Universidade de Lisboa‐CCUL Faculdade de Medicina Universidade de Lisboa Lisboa Portugal
| | - J. M. Ferro
- Instituto de Medicina Molecular Faculdade de Medicina Universidade de Lisboa Lisboa Portugal
- Serviço de Neurologia Departamento de Neurociências e Saúde Mental CHULN Faculdade de Medicina Universidade de Lisboa Lisboa Portugal
| | - J. J. Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics Faculdade de Medicina Universidade de Lisboa Lisboa Portugal
- Instituto de Medicina Molecular Faculdade de Medicina Universidade de Lisboa Lisboa Portugal
- CNS‐Campus Neurológico Sénior Torres Vedras Portugal
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