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Vallelonga F, Valente M, Tangari MM, Covolo A, Milazzo V, Di Stefano C, Sobrero G, Giudici M, Milan A, Veglio F, Lopiano L, Maule S, Romagnolo A. Hypotensive episodes at 24-h ambulatory blood pressure monitoring predict adverse outcomes in Parkinson's disease. Clin Auton Res 2024:10.1007/s10286-024-01030-7. [PMID: 38662269 DOI: 10.1007/s10286-024-01030-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Neurogenic orthostatic hypotension (nOH) is a frequent nonmotor feature of Parkinson's disease (PD), associated with adverse outcomes. Recently, 24-h ambulatory blood pressure monitoring (ABPM) showed good accuracy in diagnosing nOH. This study aims at evaluating the prognostic role of ABPM-hypotensive episodes in predicting PD disability milestones and mortality and comparing it to the well-defined prognostic role of bedside nOH. METHODS Patients with PD who underwent ABPM from January 2012 to December 2014 were retrospectively enrolled and assessed for the development of falls, fractures, dementia, bed/wheelchair confinement, hospitalization, and mortality, during an up-to-10-year follow-up. Significant ABPM-hypotensive episodes were identified when greater than or equal to two episodes of systolic BP drop ≥ 15 mmHg (compared with the average 24 h) were recorded during the awakening-to-lunch period. RESULTS A total of 99 patients (74% male, age 64.0 ± 10.1 years, and PD duration 6.4 ± 4.0 years) were enrolled. At baseline, 38.4% of patients had ABPM-hypotensive episodes and 46.5% had bedside nOH. On Kaplan-Meier analysis, patients with ABPM-hypotensive episodes showed earlier onset of falls (p = 0.001), fractures (p = 0.004), hospitalizations (p = 0.009), bed/wheelchair confinement (p = 0.032), dementia (p = 0.001), and shorter survival (8.0 versus 9.5 years; p = 0.009). At Cox regression analysis (adjusted for age, disease duration, Charlson Comorbidity Index, and Hoehn and Yahr stage) a significant association was confirmed between ABPM-hypotensive episodes and falls [odds ratio (OR) 3.626; p = 0.001), hospitalizations (OR 2.016; p = 0.038), and dementia (OR 2.926; p = 0.008), while bedside nOH was only associated with falls (OR 2.022; p = 0.039) and dementia (OR 1.908; p = 0.048). CONCLUSIONS The presence of at least two ABPM-hypotensive episodes independently predicted the development of falls, dementia, and hospitalization, showing a stronger prognostic value than the simple bedside assessment.
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Affiliation(s)
- Fabrizio Vallelonga
- Division of Internal Medicine, Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142, Km 3,95, Candiolo, 10060, Turin, Italy.
- Department of Medical Science, University of Turin, Turin, Italy.
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Matteo Valente
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marta Maria Tangari
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Anna Covolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Valeria Milazzo
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Cristina Di Stefano
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Gabriele Sobrero
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marta Giudici
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alberto Milan
- Division of Internal Medicine, Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142, Km 3,95, Candiolo, 10060, Turin, Italy
- Department of Medical Science, University of Turin, Turin, Italy
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Franco Veglio
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Simona Maule
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alberto Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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Vallelonga F, Valente M, Tangari MM, Covolo A, Milazzo V, Di Stefano C, Sobrero G, Giudici M, Milan A, Veglio F, Lopiano L, Maule S, Romagnolo A. Hypotensive episodes at 24-h Ambulatory Blood Pressure Monitoring predict adverse outcomes in Parkinson's Disease. Res Sq 2024:rs.3.rs-3904996. [PMID: 38405860 PMCID: PMC10889044 DOI: 10.21203/rs.3.rs-3904996/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Purpose Neurogenic orthostatic hypotension (nOH) is a frequent non-motor feature of Parkinson's disease (PD), associated with adverse outcomes. Recently, 24-hour ambulatory BP monitoring (ABPM) has been shown to diagnose nOH with good accuracy (in the presence of at least 2 episodes of systolic BP drop ≥ 15 mmHg compared to the average 24-h). This study aims at evaluating the prognostic role of ABPM-hypotensive episodes in predicting PD disability milestones and mortality and comparing it to well-defined prognostic role of nOH. Methods PD patients who underwent ABPM from January 2012 to December 2014 were retrospectively enrolled and assessed for the development of falls, fractures, dementia, bed/wheelchair confinement, hospitalization, mortality, during an up-to-10-year follow-up. Results Ninety-nine patients (male 74%; age: 64.0 ± 10.1 years; PD duration: 6.4 ± 4.0 years) were enrolled. At baseline, 38.4% of patients had ABPM-hypotensive episodes and 46.5% had bedside nOH.At Kaplan-Meier analysis patients with ABPM-hypotensive episodes had an earlier onset of falls (p = 0.001), fractures (p = 0.004), hospitalizations (p = 0.009), bed/wheelchair confinement (p = 0.032), dementia (p = 0.001), and showed a shorter survival (8.0vs9.5 years; p = 0.009). At Cox regression analysis (adjusted for age, disease duration, Charlson Comorbidity Index, and H&Y stage at baseline) a significant association was confirmed between ABPM-hypotensive episodes and falls (OR:3.626; p = 0.001), hospitalizations (OR:2.016; p = 0.038), and dementia (OR:2.926; p = 0.008), while bedside nOH was only associated with falls (OR 2.022; p = 0.039) and dementia (OR:1.908; p = 0.048). Conclusion The presence of at least two ABPM-hypotensive episodes independently predicted the development of falls, dementia, and hospitalization, showing a stronger prognostic value than the simple bedside assessment.
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Affiliation(s)
| | - Matteo Valente
- Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Marta Maria Tangari
- Università degli Studi di Torino Dipartimento di Neuroscienze 'Rita Levi Montalcini': Universita degli Studi di Torino Dipartimento di Neuroscienze Rita Levi Montalcini
| | - Anna Covolo
- Universita degli Studi di Torino Dipartimento di Neuroscienze Rita Levi Montalcini
| | - Valeria Milazzo
- Università degli Studi di Torino Dipartimento di Scienze Mediche: Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Cristina Di Stefano
- Università degli Studi di Torino Dipartimento di Scienze Mediche: Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Gabriele Sobrero
- Università degli Studi di Torino Dipartimento di Scienze Mediche: Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Marta Giudici
- Università degli Studi di Torino Dipartimento di Scienze Mediche: Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Alberto Milan
- Università degli Studi di Torino Dipartimento di Scienze Mediche: Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Franco Veglio
- Università degli Studi di Torino Dipartimento di Scienze Mediche: Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Leonardo Lopiano
- University of Turin Department of Neurosciences Rita Levi Montalcini: Universita degli Studi di Torino Dipartimento di Neuroscienze Rita Levi Montalcini
| | - Simona Maule
- Università degli Studi di Torino Dipartimento di Scienze Mediche: Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Alberto Romagnolo
- University of Turin Department of Neurosciences Rita Levi Montalcini: Universita degli Studi di Torino Dipartimento di Neuroscienze Rita Levi Montalcini
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Giamello JD, Bertone C, Sobrero G, Barutta L, Paglietta G, Losardo L, Lauria G. Acute coronary syndrome after initiation of amoxicillin/clavulanate. Acute Med 2023; 22:47-49. [PMID: 37039056 DOI: 10.52964/amja.0933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
We report the case of a 54 year old man referred to the Emergency Department for rapid onset of an itchy rash and oppressive epigastric pain after assumption of amoxicillin/clavulanate. Electrocardiogram aand laboratory findings were consistent with acute coronaty syndrome. After coronary angiography, diagnosis of type II Kounis syndrome was made.
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Affiliation(s)
- Jacopo Davide Giamello
- School of Emergency Medicine, University of Turin, Italy, Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Chiara Bertone
- School of Emergency Medicine, University of Turin, Italy, Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Gabriele Sobrero
- Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Letizia Barutta
- Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Giulia Paglietta
- School of Emergency Medicine, University of Turin, Italy, Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Luigi Losardo
- Department of Cardiology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Giuseppe Lauria
- Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
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Marsili L, Duque KR, Sturchio A, Sobrero G, Premoli I, Dwivedi AK, Espay AJ, Merola A. Droxidopa reduces postural sway in Parkinson disease patients with orthostatic hypotension. Parkinsonism Relat Disord 2022; 99:62-64. [PMID: 35605513 DOI: 10.1016/j.parkreldis.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/30/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022]
Abstract
We evaluate the effect of droxidopa on gait and balance measures in nine patients with Parkinson's disease and neurogenic orthostatic hypotension. Computerized gait/balance analysis showed a significant effect of droxidopa in reducing postural sway. Future studies may determine if such effect translates into improvement in postural reflexes and falls.
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Affiliation(s)
- Luca Marsili
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Kevin R Duque
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Andrea Sturchio
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA; Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institute, 171 76, Stockholm, Sweden.
| | - Gabriele Sobrero
- Autonomic and Orthostatic Hypotension Unit, Department of Medical Sciences; AOU Città della Salute e della Scienza di Torino, Turin, Italy.
| | - Isabella Premoli
- Biomarker Department, Division of Experimental Medicine, H. Lundbeck A/S, 2500, Copenhagen, Denmark; Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK.
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, Texas, USA.
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Aristide Merola
- Department of Neurology, Wexner Medical Center, Ohio State University, Columbus, OH, USA.
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Vallelonga F, Sobrero G, Merola A, Valente M, Giudici M, Di Stefano C, Milazzo V, Burrello J, Burrello A, Veglio F, Romagnolo A, Maule S. Machine learning applied to ambulatory blood pressure monitoring: a new tool to diagnose autonomic failure? J Neurol 2022; 269:3833-3840. [PMID: 35192033 PMCID: PMC9217832 DOI: 10.1007/s00415-022-11020-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 10/29/2022]
Abstract
BACKGROUND Autonomic failure (AF) complicates Parkinson's disease (PD) in one-third of cases, resulting in complex blood pressure (BP) abnormalities. While autonomic testing represents the diagnostic gold standard for AF, accessibility to this examination remains limited to a few tertiary referral centers. OBJECTIVE The present study sought to investigate the accuracy of a machine learning algorithm applied to 24-h ambulatory BP monitoring (ABPM) as a tool to facilitate the diagnosis of AF in patients with PD. METHODS Consecutive PD patients naïve to vasoactive medications underwent 24 h-ABPM and autonomic testing. The diagnostic accuracy of a Linear Discriminant Analysis (LDA) model exploiting ABPM parameters was compared to autonomic testing (as per a modified version of the Composite Autonomic Symptom Score not including the sudomotor score) in the diagnosis of AF. RESULTS The study population consisted of n = 80 PD patients (33% female) with a mean age of 64 ± 10 years old and disease duration of 6.2 ± 4 years. The prevalence of AF at the autonomic testing was 36%. The LDA model showed 91.3% accuracy (98.0% specificity, 79.3% sensitivity) in predicting AF, significantly higher than any of the ABPM variables considered individually (hypotensive episodes = 82%; reverse dipping = 79%; awakening hypotension = 74%). CONCLUSION LDA model based on 24-h ABPM parameters can effectively predict AF, allowing greater accessibility to an accurate and easy to administer test for AF. Potential applications range from systematic AF screening to monitoring and treating blood pressure dysregulation caused by PD and other neurodegenerative disorders.
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Affiliation(s)
- Fabrizio Vallelonga
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy.
| | - G Sobrero
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - A Merola
- Department of Neurology, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - M Valente
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - M Giudici
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - C Di Stefano
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - V Milazzo
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - J Burrello
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - A Burrello
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
| | - F Veglio
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - A Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Turin, Italy
| | - S Maule
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
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Ledda C, Montanaro E, Imbalzano G, Merola A, Bruno I, Artusi CA, Zibetti M, Rizzone MG, Bozzali M, Sobrero G, Vallelonga F, Maule S, Lopiano L, Romagnolo A. Burden of caregiving for cardiovascular dysautonomia in Parkinson's disease. Clin Auton Res 2022; 32:455-461. [PMID: 36030471 PMCID: PMC9719446 DOI: 10.1007/s10286-022-00888-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/18/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE We sought to estimate the impact of cardiovascular autonomic neuropathy (cAN) on informal caregivers of patients with Parkinson's disease (PD), defined as individuals providing regular care to a friend, partner, or family member with PD, and to evaluate the mutual relationship between caregiver burden and patient health-related quality of life (HRQoL). METHODS We enrolled 36 consecutive patients with PD and their informal caregivers. Patients underwent a detailed motor, autonomic, cognitive, and functional assessment. Caregivers were assessed using the Zarit Burden Interview (ZBI). Differences in caregiver burden, expressed by the ZBI score, and strength of association between caregiver burden, cAN, and HRQoL were assessed using analysis of covariance (ANCOVA), logistic regression, and linear regression analyses. Analyses were adjusted for patients' age, PD duration, and motor and cognitive disability, as well as caregivers' age. RESULTS Moderate-severe caregiver burden was reported in 41.7% of PDcAN+ versus 8.7% of PDcAN- (p < 0.001). The ZBI score was increased in PDcAN+ versus PDcAN- (31.5 ± 3.4 versus 15.2 ± 2.3; p < 0.001), with tenfold higher odds (p = 0.012) of moderate-severe caregiver burden in PDcAN+, even after adjusting for potential confounders. The ZBI score correlated with cAN severity (p = 0.005), global autonomic impairment (p = 0.012), and HRQoL impairment (p < 0.001). CONCLUSION These results highlight the significant impact of cAN on PD caregivers and the need for targeted interventions addressing this frequently overlooked and insufficiently treated source of nonmotor disability in PD.
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Affiliation(s)
- Claudia Ledda
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Elisa Montanaro
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Gabriele Imbalzano
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Aristide Merola
- grid.261331.40000 0001 2285 7943Department of Neurology, Wexner Medical Center, Ohio State University, Columbus, OH USA
| | - Ilaria Bruno
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Carlo Alberto Artusi
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Maurizio Zibetti
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Mario Giorgio Rizzone
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Marco Bozzali
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Gabriele Sobrero
- grid.7605.40000 0001 2336 6580Department of Medical Sciences, Internal Medicine Division, Autonomic Unit and Hypertension Unit, University of Turin, Turin, Italy
| | - Fabrizio Vallelonga
- grid.7605.40000 0001 2336 6580Department of Medical Sciences, Internal Medicine Division, Autonomic Unit and Hypertension Unit, University of Turin, Turin, Italy
| | - Simona Maule
- grid.7605.40000 0001 2336 6580Department of Medical Sciences, Internal Medicine Division, Autonomic Unit and Hypertension Unit, University of Turin, Turin, Italy
| | - Leonardo Lopiano
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
| | - Alberto Romagnolo
- grid.7605.40000 0001 2336 6580Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy ,SC Neurologia 2U, AOU Città della Salute e della Scienza, Via Cherasco 15, 10126 Turin, Italy
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Vallelonga F, Sobrero G, Giudici M, Valente M, Milazzo V, Di Stefano C, Maule S. Screening indexes for cardiovascular autonomic failure in Parkinson's disease. J Neurol Sci 2021; 428:117571. [PMID: 34265574 DOI: 10.1016/j.jns.2021.117571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/20/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
Autonomic failure (AF) is a common source of orthostatic hypotension (OH) in Parkinson's disease (PD). The diagnosis of AF is difficult on clinical grounds alone. We used autonomic testing and 24-h BP monitoring (ABPM) in 122 PD patients to evaluate the diagnostic accuracy of AF by (1) the reduced heart rate increase to fall in blood pressure (BP) ratio (ΔHR/ΔSBP), (2) reverse dipping (RD), and (3) increased diurnal systolic BP standard deviation (SD-SBP). Among patients with OH, ΔHR/ΔSBP yielded the best accuracy (85%), with excellent sensitivity (92%) and acceptable specificity (67%). RD and, to a lesser extent, SD-SBP had high specificity (93% and 73%, respectively) but low sensitivity, resulting in overall moderate accuracy (66% and 55%, respectively). In patients with OH, the addition of ABPM indexes to ΔHR/ΔSBP did not result in a significant improvement of accuracy. In patients without OH, RD and SD-SBP may be useful showing an accuracy of 72% and 81%, respectively, with high negative predictive value when both RD and increased SD-SBP are absent. The integration of bedside (∆HR/∆SBP) and ABPM-derived indexes can assist the clinician in screening PD patients for AF and guide referral to autonomic testing.
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Affiliation(s)
- F Vallelonga
- Autonomic and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - G Sobrero
- Autonomic and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy.
| | - M Giudici
- Autonomic and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Valente
- Autonomic and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - V Milazzo
- Autonomic and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - C Di Stefano
- Autonomic and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - S Maule
- Autonomic and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
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Sturchio A, Dwivedi AK, Marsili L, Hadley A, Sobrero G, Heldman D, Maule S, Lopiano L, Comi C, Versino M, Espay AJ, Merola A. Kinematic but not clinical measures predict falls in Parkinson-related orthostatic hypotension. J Neurol 2020; 268:1006-1015. [PMID: 32979099 DOI: 10.1007/s00415-020-10240-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We sought to test the hypothesis that technology could predict the risk of falls in Parkinson's disease (PD) patients with orthostatic hypotension (OH) with greater accuracy than in-clinic assessment. METHODS Twenty-six consecutive PD patients with OH underwent clinical (including home-like assessments of activities of daily living) and kinematic evaluations of balance and gait as well as beat-to-beat blood pressure (BP) monitoring to estimate their association with the risk of falls. Fall frequency was captured by a diary collected prospectively over 6 months. When applicable, the sensitivity, specificity, and diagnostic accuracy were measured using the area under the receiver operating characteristics curve (AUC). Additional in-clinic assessments included the OH Symptom Assessment (OHSA), the OH Daily Activity Score (OHDAS), and the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). RESULTS The prevalence of falls was 53.8% over six months. There was no association between the risk of falls and test of gait and postural stability (p ≥ 0.22) or home-like activities of daily living (p > 0.08). Conversely, kinematic data (waist sway during time-up-and-go, jerkiness, and centroidal frequency during postural sway with eyes-opened) predicted the risk of falls with high sensitivity and specificity (> 80%; AUC ≥ 0.81). There was a trend for higher risk of falls in patients with orthostatic mean arterial pressure ≤ 75 mmHg. CONCLUSIONS Kinematic but not clinical measures predicted falls in PD patients with OH. Orthostatic mean arterial pressure ≤ 75 mmHg may represent a hemodynamic threshold below which falls become more prevalent, supporting the aggressive deployment of corrective measures.
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Affiliation(s)
- Andrea Sturchio
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
- University of Pavia, Pavia, Italy
- Neurology Unit, Varese ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Luca Marsili
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Aaron Hadley
- Great Lakes NeuroTechnologies, Cleveland, OH, USA
| | - Gabriele Sobrero
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
- Ambulatorio per le Disautonomie e l'Ipotensione Ortostatica, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Simona Maule
- Ambulatorio per le Disautonomie e l'Ipotensione Ortostatica, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy
| | - Cristoforo Comi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Maurizio Versino
- Neurology Unit, Varese ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
- DMC, University of Insubria, Varese, Italy
| | - Alberto J Espay
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Aristide Merola
- Department of Neurology, Wexner Medical Center, Ohio State University, Columbus, OH, USA.
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Chirra M, Marsili L, Wattley L, Sokol LL, Keeling E, Maule S, Sobrero G, Artusi CA, Romagnolo A, Zibetti M, Lopiano L, Espay AJ, Obeidat AZ, Merola A. Telemedicine in Neurological Disorders: Opportunities and Challenges. Telemed J E Health 2019; 25:541-550. [PMID: 30136898 PMCID: PMC6664824 DOI: 10.1089/tmj.2018.0101] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction: Telemedicine represents an emerging model for the assessment and management of various neurological disorders. Methods: We sought to discuss opportunities and challenges for the integration of telemedicine in the management of common and uncommon neurological disorders by reviewing and appraising studies that evaluate telemedicine as a means to facilitate the access to care, deliver highly specialized visits, diagnostic consultations, rehabilitation, and remote monitoring of neurological disorders. Results: Opportunities for telemedicine in neurological disorders include the replacement of or complement to in-office evaluations, decreased time between follow-up visits, reduction in disparities in access to healthcare, and promotion of education and training through interactions between primary care physicians and tertiary referral centers. Critical challenges include the integration of the systems for data monitoring with an easy-to-use, secure, and cost-effective platform that is both widely adopted by patients and healthcare systems and embraced by international scientific societies. Conclusions: Multiple applications may spawn from a model based on digitalized healthcare services. Integrated efforts from multiple stakeholders will be required to develop an interoperable software platform capable of providing not only a holistic approach to care but also one that reduces disparities in the access to care.
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Affiliation(s)
- Martina Chirra
- Division of Hematology-Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
- Department of Oncology, Medical Oncology Unit, University of Siena, Siena, Italy
| | - Luca Marsili
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
| | - Linsdey Wattley
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Leonard L. Sokol
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Elizabeth Keeling
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
| | - Simona Maule
- Autonomic Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Gabriele Sobrero
- Autonomic Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Alberto Romagnolo
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Maurizio Zibetti
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Alberto J. Espay
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
| | - Ahmed Z. Obeidat
- Department of Neurology and Rehabilitation Medicine, The Waddell Center for Multiple Sclerosis, University of Cincinnati, Cincinnati, Ohio
| | - Aristide Merola
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
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Vallelonga F, Romagnolo A, Merola A, Sobrero G, Di Stefano C, Milazzo V, Burrello J, Burrello A, Zibetti M, Milan A, Veglio F, Maule S. Detection of orthostatic hypotension with ambulatory blood pressure monitoring in parkinson's disease. Hypertens Res 2019; 42:1552-1560. [PMID: 31118487 DOI: 10.1038/s41440-019-0267-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 04/10/2019] [Accepted: 04/17/2019] [Indexed: 01/07/2023]
Abstract
We sought to test the accuracy of 24-hours ambulatory blood pressure (BP) monitoring (ABPM) for the detection of orthostatic hypotension (OH) in Parkinson's disease (PD). A total of 113 patients referred for autonomic testing between January 2015 and June 2017 underwent ABPM and office BP measurements in supine and standing positions. The study population consisted of 81 males and 32 females with PD duration of 6.5 ± 4.1 years and Hoehn and Yahr staging of 1 (13.3%), 1.5 (20.4%), 2 (27.4%), 2.5 (23.9%), 3 (13.3%), and 4 (1.8%). Motor fluctuations were present in 44% of patients. The data from office BP recordings were compared to selected ABPM parameters, and the results showed an association between OH and (a) ABPM-detected hypotensive episodes (Hypo-ep) and (b) ABPM-detected awakening hypotension (Hypo-aw). Having 2 or more Hypo-ep episodes ≤15 mmHg (systolic) compared to average 24-h systolic BP [Formula: see text] yielded 75% diagnostic accuracy for OH, while the presence of at least one [Formula: see text] within 90 min after getting up [Formula: see text] yielded 93% specificity for OH. A diagnostic accuracy of 87.6% was achieved when including daytime and nighttime ABPM values, weighted BP variability, systolic and diastolic BP loads, nocturnal dipping, and postprandial hypotension in a computerized prediction algorithm. In conclusion, our findings suggest that selected ABPM parameters, such as the number of hypotensive episodes and the presence of awakening hypotension, may be used to screen patients for OH, while using a computerized prediction algorithm that includes all ABPM parameters provides the greatest diagnostic accuracy.
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Affiliation(s)
- Fabrizio Vallelonga
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy.
| | - Alberto Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Turin, Italy
| | - Aristide Merola
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Gabriele Sobrero
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - Cristina Di Stefano
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - Valeria Milazzo
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - Jacopo Burrello
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - Alessio Burrello
- Department of Electronics and telecommunications, Polytechnic University of Turin, Turin, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Turin, Italy
| | - Alberto Milan
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - Franco Veglio
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - Simona Maule
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
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Vallelonga F, Di Stefano C, Merola A, Romagnolo A, Sobrero G, Milazzo V, Burrello A, Burrello J, Zibetti M, Veglio F, Maule S. Blood pressure circadian rhythm alterations in alpha-synucleinopathies. J Neurol 2019; 266:1141-1152. [DOI: 10.1007/s00415-019-09244-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/09/2019] [Accepted: 02/14/2019] [Indexed: 12/28/2022]
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Milazzo V, Di Stefano C, Vallelonga F, Sobrero G, Zibetti M, Romagnolo A, Merola A, Milan A, Espay AJ, Lopiano L, Veglio F, Maule S. Reverse blood pressure dipping as marker of dysautonomia in Parkinson disease. Parkinsonism Relat Disord 2018; 56:82-87. [PMID: 30057156 DOI: 10.1016/j.parkreldis.2018.06.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/06/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION We sought to evaluate if the presence of abnormal circadian loss of nocturnal blood pressure dipping (reverse dipping) is associated with cardiovascular dysautonomia, a major source of morbidity in Parkinson disease. METHODS Consecutive Parkinson disease patients were enrolled in this cross-sectional study between January 2015 and June 2017. All subjects underwent same-day autonomic testing and 24-h ambulatory blood pressure monitoring. Cardiovascular dysautonomia was defined by the presence of at least one moderate or severe cardiovagal and adrenergic test abnormality. RESULTS We recruited 114 PD patients (79 males; mean age 64 ± 10 years; disease duration 6 ± 4 years). Cardiovascular dysautonomia was present in 32% (36/114). The blood pressure patterns were normal dipping in 28.9% (n = 33), extreme dipping in 6.1% (n = 7), reduced dipping in 32.5% (n = 37), and reverse dipping in 32.5% (n = 37). Reverse dipping was disproportionately prevalent in subjects with cardiovascular dysautonomia (69% vs 15%, p < 0.001). The diagnostic accuracy of reverse dipping in discriminating cardiovascular dysautonomia (AUC 0.791, specificity 84%, sensitivity 69%) was higher than that of bedside blood pressure ascertainment of neurogenic orthostatic hypotension (0.681, 66%, 69%) and supine hypertension (0.641, 78%, 50%). CONCLUSIONS Reverse nocturnal blood pressure dipping is a marker of cardiovascular dysautonomia in Parkinson disease, which can be screened for with ease and affordability using ambulatory blood pressure monitoring.
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Affiliation(s)
- Valeria Milazzo
- Department of Medical Sciences, Autonomic Unit and Hypertension Unit, University of Turin, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | - Cristina Di Stefano
- Department of Medical Sciences, Autonomic Unit and Hypertension Unit, University of Turin, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | - Fabrizio Vallelonga
- Department of Medical Sciences, Autonomic Unit and Hypertension Unit, University of Turin, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | - Gabriele Sobrero
- Department of Medical Sciences, Autonomic Unit and Hypertension Unit, University of Turin, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Alberto Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Aristide Merola
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Alberto Milan
- Department of Medical Sciences, Autonomic Unit and Hypertension Unit, University of Turin, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Franco Veglio
- Department of Medical Sciences, Autonomic Unit and Hypertension Unit, University of Turin, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | - Simona Maule
- Department of Medical Sciences, Autonomic Unit and Hypertension Unit, University of Turin, Città Della Salute e Della Scienza Hospital, Turin, Italy.
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Milazzo V, Di Stefano C, Milan A, Ravera A, Sobrero G, Sabia L, Veglio F, Maule S. Cardiovascular complications in patients with autonomic failure. Clin Auton Res 2015; 25:133-40. [PMID: 25791260 DOI: 10.1007/s10286-015-0275-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/11/2014] [Indexed: 12/31/2022]
Abstract
Patients with autonomic failure are characterized by orthostatic hypotension, supine hypertension, high blood pressure variability, blunted heart rate variability, and often have a "non-dipping" or "reverse dipping" pattern on 24-h ambulatory blood pressure monitoring. These alterations may lead to cardiovascular and cerebrovascular changes, similar to the target organ damage found in hypertension. Often patients with autonomic failure are on treatment with anti-hypotensive drugs, which may worsen supine hypertension. The aim of this review is to summarize the evidence for cardiac, vascular, renal, and cerebrovascular damage in patients with autonomic failure.
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Affiliation(s)
- Valeria Milazzo
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy,
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Domingos J, Augustine D, Leeson P, Noble J, Doan HL, Boubrit L, Cheikh-Khalifa R, Laveau F, Djebbar M, Pousset F, Isnard R, Hammoudi N, Lisi M, Cameli M, Di Tommaso C, Curci V, Reccia R, Maccherini M, Henein MY, Mondillo S, Leitman M, Vered Z, Rashid H, Yalcin MU, Gurses KM, Kocyigit D, Evranos B, Yorgun H, Sahiner L, Kaya B, Aytemir K, Ozer N, Bertella E, Petulla' M, Baggiano A, Mushtaq S, Russo E, Gripari P, Innocenti E, Andreini D, Tondo C, Pontone G, Necas J, Kovalova S, Hristova K, Shiue I, Bogdanva V, Teixido Tura G, Sanchez V, Rodriguez-Palomares J, Gutierrez L, Gonzalez-Alujas T, Garcia-Dorado D, Forteza A, Evangelista A, Timoteo AT, Aguiar Rosa S, Cruz Ferreira R, Campbell R, Carrick D, Mccombe C, Tzemos N, Berry C, Sonecki P, Noda M, Setoguchi M, Ikenouchi T, Nakamura T, Yamamoto Y, Murakami T, Katou Y, Usui M, Ichikawa K, Isobe M, Kwon B, Roh J, Kim H, Ihm S, Barron AJ, Francis D, Mayet J, Wensel R, Kosiuk J, Dinov B, Bollmann A, Hindricks G, Breithardt O, Rio P, Moura Branco L, Galrinho A, Cacela D, Pinto Teixeira P, Afonso Nogueira M, Pereira-Da-Silva T, Abreu J, Teresa Timoteo A, Cruz Ferreira R, Pavlyukova E, Tereshenkova E, Karpov R, Piatkowski R, Kochanowski J, Opolski G, Barbier P, Mirea O, Guglielmo M, Savioli G, Cefalu C, Pudil R, Horakova L, Rozloznik M, Balestra C, Rimbas R, Enescu O, Calin S, Vinereanu D, Karsenty C, Hascoet S, Hadeed K, Semet F, Dulac Y, Alacoque X, Leobon B, Acar P, Dharma S, Sukmawan R, Soesanto A, Vebiona K, Firdaus I, Danny S, Driessen MMP, Sieswerda G, Post M, Snijder R, Van Dijk A, Leiner T, Meijboom F, Chrysohoou C, Tsitsinakis G, Tsiachris D, Aggelis A, Herouvim E, Vogiatzis I, Pitsavos C, Koulouris G, Stefanadis C, Erdei T, Edwards J, Braim D, Yousef Z, Fraser A, Avenatti E, Magnino C, Omede' P, Presutti D, Moretti C, Iannaccone A, Ravera A, Gaita F, Milan A, Veglio F, Barbier P, Scali M, Simioniuc A, Guglielmo M, Savioli G, Cefalu C, Mirea O, Fusini L, Dini F, Okura H, Murata E, Kataoka T, Zaroui A, Ben Halima M, Mourali M, Mechmeche R, Rodriguez Palomares JF, Gutierrez L, Maldonado G, Garcia G, Otaegui I, Garcia Del Blanco B, Teixido G, Gonzalez Alujas M, Evangelista A, Garcia Dorado D, Godinho AR, Correia A, Rangel I, Rocha A, Rodrigues J, Araujo V, Almeida P, Macedo F, Maciel M, Rekik B, Mghaieth F, Aloui H, Boudiche S, Jomaa M, Ayari J, Tabebi N, Farhati A, Mourali S, Dekleva M, Markovic-Nikolic N, Zivkovic M, Stankovic A, Boljevic D, Korac N, Beleslin B, Arandjelovic A, Ostojic M, Galli E, Guirette Y, Auffret V, Daudin M, Fournet M, Mabo P, Donal E, Chin CWL, Luo E, Hwan J, White A, Newby D, Dweck M, Carstensen HG, Larsen LH, Hassager C, Kofoed KF, Jensen JS, Mogelvang R, Kowalczyk M, Debska M, Kolesnik A, Dangel J, Kawalec W, Migliore R, Adaniya M, Barranco M, Miramont G, Gonzalez S, Tamagusuku H, Davidsen ES, Kuiper KKJ, Matre K, Gerdts E, Igual Munoz B, Maceira Gonzalez A, Erdociain Perales M, Estornell Erill J, Valera Martinez F, Miro Palau V, Piquer Gil M, Sepulveda Sanchez P, Cervera Zamora A, Montero Argudo A, Placido R, Silva Marques J, Magalhaes A, Guimaraes T, Nobre E Menezes M, Goncalves S, Ramalho A, Robalo Martins S, Almeida A, Nunes Diogo A, Abid L, Ben Kahla S, Charfeddine S, Abid D, Kammoun S, Tounsi A, Abid L, Abid D, Charfeddine S, Hammami R, Triki F, Akrout M, Mallek S, Hentati M, Kammoun S, Sirbu CF, Berrebi A, Huber A, Folliguet T, Yang LT, Shih J, Liu Y, Li Y, Tsai L, Luo C, Tsai W, Babukov R, Bartosh F, Bazilev V, Muraru D, Cavalli G, Addetia K, Miglioranza M, Veronesi F, Mihaila S, Tadic M, Cucchini U, Badano L, Lang R, Miyazaki S, Slavich M, Miyazaki T, Figini F, Lativ A, Chieffo A, Montrfano M, Alfieri O, Colombo A, Agricola E, Liu D, Hu K, Herrmann S, Stoerk S, Kramer B, Ertl G, Bijnens B, Weidemann F, Brand M, Butz T, Tzikas S, Van Bracht M, Roeing J, Wennemann R, Christ M, Grett M, Trappe HJ, Scherzer S, Geroldinger A, Krenn L, Roth C, Gangl C, Maurer G, Rosenhek R, Neunteufl T, Binder T, Bergler-Klein J, Martins E, Pinho T, Leite S, Azevedo O, Belo A, Campelo M, Amorim S, Rocha-Goncalves F, Goncalves L, Silva-Cardoso J, Ahn H, Kim K, Jeon H, Youn H, Haland T, Saberniak J, Leren I, Edvardsen T, Haugaa K, Ziolkowska L, Boruc A, Kowalczyk M, Turska-Kmiec A, Zubrzycka M, Kawalec W, Monivas Palomero V, Mingo Santos S, Goirigolzarri Artaza J, Rodriguez Gonzalez E, Rivero Arribas B, Castro Urda V, Dominguez Rodriguez F, Mitroi C, Gracia Lunar I, Fernadez Lozano I, Palecek T, Masek M, Kuchynka P, Fikrle M, Spicka I, Rysava R, Linhart A, Saberniak J, Hasselberg N, Leren I, Haland T, Borgquist R, Platonov P, Edvardsen T, Haugaa K, Ancona R, Comenale Pinto S, Caso P, Coopola M, Arenga F, Rapisarda O, D'onofrio A, Sellitto V, Calabro R, Rosca M, Popescu B, Calin A, Mateescu A, Beladan C, Jalba M, Rusu E, Zilisteanu D, Ginghina C, Pressman G, Cepeda-Valery B, Romero-Corral A, Moldovan R, Saenz A, Orban M, Samuel S, Fijalkowski M, Fijalkowska M, Gilis-Siek N, Blaut K, Galaska R, Sworczak K, Gruchala M, Fijalkowski M, Nowak R, Gilis-Siek N, Fijalkowska M, Galaska R, Gruchala M, Ikonomidis I, Triantafyllidi H, Trivilou P, Tzortzis S, Papadopoulos C, Pavlidis G, Paraskevaidis I, Lekakis J, Kaymaz C, Aktemur T, Poci N, Ozturk S, Akbal O, Yilmaz F, Tokgoz Demircan H, Kirca N, Tanboga I, Ozdemir N, Greiner S, Jud A, Aurich M, Hess A, Hilbel T, Hardt S, Katus H, D'ascenzi F, Cameli M, Alvino F, Lisi M, Focardi M, Solari M, Bonifazi M, Mondillo S, Konopka M, Krol W, Klusiewicz A, Burkhard K, Chwalbinska J, Pokrywka A, Dluzniewski M, Braksator W, King GJ, Coen K, Gannon S, Fahy N, Kindler H, Clarke J, Iliuta L, Rac-Albu M, Placido R, Robalo Martins S, Guimaraes T, Nobre E Menezes M, Cortez-Dias N, Francisco A, Silva G, Goncalves S, Almeida A, Nunes Diogo A, Kyu K, Kong W, Songco G, Galupo M, Castro M, Shin Hnin W, Ronald Lee C, Poh K, Milazzo V, Di Stefano C, Tosello F, Leone D, Ravera A, Sabia L, Sobrero G, Maule S, Veglio F, Milan A, Jamiel AM, Ahmed AM, Farah I, Al-Mallah MH, Petroni R, Magnano R, Bencivenga S, Di Mauro M, Petroni S, Altorio S, Romano S, Penco M, Kumor M, Lipczynska M, Klisiewicz A, Wojcik A, Konka M, Kozuch K, Szymanski P, Hoffman P, Rimbas R, Rimbas M, Enescu O, Mihaila S, Calin S, Vinereanu D, Donal E, Reynaud A, Lund L, Persson H, Hage C, Oger E, Linde C, Daubert J, Maria Oliveira Lima M, Costa H, Gomes Da Silva M, Noman Alencar M, Carmo Pereira Nunes M, Costa Rocha M, Abid L, Charfeddine S, Ben Kahla S, Abid D, Siala A, Hentati M, Kammoun S, Kovalova S, Necas J, Ozawa K, Funabashi N, Takaoka H, Kobayashi Y, Matsumura Y, Wada M, Hirakawa D, Yasuoka Y, Morimoto N, Takeuchi H, Kitaoka H, Sugiura T, Lakkas L, Naka K, Ntounousi E, Gkirdis I, Koutlas V, Bechlioulis A, Pappas K, Katsouras C, Siamopoulos K, Michalis L, Naka K, Evangelou D, Kalaitzidis R, Bechlioulis A, Lakkas L, Gkirdis I, Tzeltzes G, Nakas G, Katsouras C, Michalis L, Generati G, Bandera F, Pellegrino M, Labate V, Alfonzetti E, Guazzi M, Zagatina A, Zhuravskaya N, Al-Mallah M, Alsaileek A, Qureshi W, Karsenty C, Hascoet S, Peyre M, Hadeed K, Alacoque X, Amadieu R, Leobon B, Dulac Y, Acar P, Yamanaka Y, Sotomi Y, Iwakura K, Inoue K, Toyoshima Y, Tanaka K, Oka T, Tanaka N, Orihara Y, Fujii K, Soulat-Dufour L, Lang S, Boyer-Chatenet L, Van Der Vynckt C, Ederhy S, Adavane S, Haddour N, Boccara F, Cohen A, Huitema M, Boerman S, Vorselaars V, Grutters J, Post M, Gopal AS, Saha S, Toole R, Kiotsekoglou A, Cao J, Reichek N, Meyer CG, Altiok E, Al Ateah G, Lehrke M, Becker M, Lotfi S, Autschbach R, Marx N, Hoffmann R, Frick M, Nemes A, Sepp R, Kalapos A, Domsik P, Forster T, Caro Codon J, Blazquez Bermejo Z, Lopez Fernandez T, Valbuena Lopez SC, Iniesta Manjavacas AM, De Torres Alba F, Dominguez Melcon F, Pena Conde L, Moreno Yanguela M, Lopez-Sendon JL, Nemes A, Lengyel C, Domsik P, Kalapos A, Orosz A, Varkonyi T, Forster T, Rendon J, Saldarriaga CI, Duarte N, Nemes A, Domsik P, Kalapos A, Forster T, Nemes A, Domsik P, Kalapos A, Sepp R, Foldeak D, Borbenyi Z, Forster T, Hamdy A, Fereig H, Nabih M, Abdel-Aziz A, Ali A, Broyd C, Wielandts JY, De Buck S, Michielsen K, Louw R, Garweg C, Nuyts J, Ector J, Maes F, Heidbuchel H, Gillis K, Bala G, Tierens S, Cosyns B, Maurovich-Horvat P, Horvath T, Jermendy A, Celeng C, Panajotu A, Bartykowszki A, Karolyi M, Tarnoki A, Jermendy G, Merkely B. Poster session 2: Thursday 4 December 2014, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Marinelli M, Gianesin B, Balocco M, Beruto P, Bruzzone C, Carrara P, Gallusi P, Macco A, Musso M, Oliveri E, Pelucchi S, Sobrero G, Villa R, Forni GL. Total Iron-Overload Measurement in the Human Liver Region by the Magnetic Iron Detector. IEEE Trans Biomed Eng 2010; 57:2295-303. [DOI: 10.1109/tbme.2010.2053204] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Susperreguy S, Miras MB, Montesinos MM, Mascanfroni ID, Muñoz L, Sobrero G, Silvano L, Masini-Repiso AM, Coleoni AH, Targovnik HM, Pellizas CG. Growth hormone (GH) treatment reduces peripheral thyroid hormone action in girls with Turner syndrome. Clin Endocrinol (Oxf) 2007; 67:629-36. [PMID: 17666093 DOI: 10.1111/j.1365-2265.2007.02936.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Turner syndrome (TS) is an indication for GH therapy in spite of the modest growth response. Somatic growth depends not only on GH insulin-like growth factor I (IGF-I) axis but also on thyroid hormone (TH) status. We have previously reported that supraphysiological IGF-I levels diminished TH actions in rat tissues by reducing the nuclear TH receptor (TR). GH treatment to TS patients induces high IGF-I levels and therefore a reduction of TH action in tissues may be expected. We aimed at evaluating the effect of GH therapy in TS girls on peripheral TH action. DESIGN AND PATIENTS We set up a reverse transcription-polymerase chain reaction (RT-PCR) for TR mRNA estimation in peripheral blood mononuclear cells (PBMC) and compared TR mRNA levels from 10 normal, 10 TS and 10 TS girls under GH therapy (0.33 mg/kg/week for 0.5-2 years). MEASUREMENTS After RNA extraction from PBMC, TR and beta-actin mRNAs were coamplified by RT-PCR. In addition serum biochemical markers of TH action were measured: thyrotropin (TSH), sex hormone binding globulin (SHBG), osteocalcin (OC), beta-crosslaps (beta-CL), iodothyronines by electrochemiluminescency and IGF-I by immunoradiometric assay (IRMA) with extraction. RESULTS TR mRNAs from PBMC were reduced in TS patients under GH treatment. In turn, serum TSH, OC, beta-CL and IGF-I were increased while SHBG was reduced by GH treatment in TS patients. CONCLUSIONS GH treatment reduced TR expression in PBMC and biochemical serum markers of TH action. These results suggest that GH treatment in TS patients impair peripheral TH action at tissue level and prompt a role in the reduced growth response to the therapy.
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Affiliation(s)
- S Susperreguy
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Argentina
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Marinelli M, Gianesin B, Lamagna M, Lavagetto A, Oliveri E, Saccone M, Sobrero G, Terenzani L, Forni G. Whole liver iron overload measurement by a non cryogenic magnetic susceptometer. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.ics.2006.12.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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