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Kanuri SH, Shivamurthy P, Albadareen R, Elbey MA, Gopinathannair R, Lakkireddy D. Autoimmune dysautonomia secondary to chronic organophosphate exposure. HeartRhythm Case Rep 2021; 7:522-524. [PMID: 34434699 PMCID: PMC8377226 DOI: 10.1016/j.hrcr.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | - Rawan Albadareen
- Department of Neurology, Overland Park Regional Medical Center, Overland Park, Kansas
| | - Mehmet Ali Elbey
- Kansas City Heart Rhythm Institute (KCHRI), Overland Park, Kansas
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Bosone D, Fogari R, Ramusino MC, Ghiotto N, Guaschino E, Zoppi A, D'Angelo A, Costa A. Ambulatory 24-h ECG monitoring and cardiovascular autonomic assessment for the screening of silent myocardial ischemia in elderly type 2 diabetic hypertensive patients. Heart Vessels 2017; 32:507-13. [PMID: 27714469 DOI: 10.1007/s00380-016-0898-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/30/2016] [Indexed: 02/07/2023]
Abstract
The aim of the study was to evaluate the usefulness of Holter monitoring for the detection of silent myocardial ischemia (SMI) in elderly type 2 diabetic patients with hypertension and the possible relationship between SMI and cardiovascular autonomic neuropathy (CAN). Two hundred and forty-three asymptomatic outpatients, aged 65-75 years, with type 2 diabetes and essential hypertension underwent 24-h ECG monitoring and 5 tests for the evaluation of both parasympathetic (heart rate variability, response to breath deeping, and Valsalva manoeuvre) and sympathetic (cold pressor test and orthostatic hypotension test) autonomic function. A total of 518 asymptomatic episodes of ST depression during Holter monitoring indicative of SMI were detected in 51 of the 243 studied patients (20.9 %). None of the patients with ST depression episodes exhibited a normal response to at least one of the evaluated autonomic function tests, whereas 22 of the 192 patients without ST changes (11.4 %) exhibited a normal response to all tests. Abnormality in both parasympathetic and sympathetic function test responses was found in 94.1 % of patients with ST depression episodes vs 26.1 % of those without ST changes (P < 0.001). Statistical evaluation of the relationship between the abnormal response to single autonomic function test and episodes of ST depression was highly significant for all the 5 tests (P < 0.001). These results indicate that: (a) Holter monitoring enables to detect ST segment changes indicative of SMI in 20.9 % of elderly diabetic patients with hypertension; (b) the presence of autonomic cardiac dysfunction in these patients suggests a role of diabetic neuropathy in the pathogenesis of SMI; and
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Campolo J, De Maria R, Cozzi L, Parolini M, Bernardi S, Proserpio P, Nobili L, Gelosa G, Piccolo I, Agostoni EC, Trivella MG, Marraccini P. Antioxidant and inflammatory biomarkers for the identification of prodromal Parkinson's disease. J Neurol Sci 2016; 370:167-172. [PMID: 27772753 DOI: 10.1016/j.jns.2016.09.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 07/14/2016] [Revised: 09/09/2016] [Accepted: 09/25/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We explored the role of oxidative stress and inflammatory molecules as potential Parkinson (PD) biomarkers and correlated biological with non-motor abnormalities (olfactory impairment and dysautonomia), in patients with idiopathic REM behavior disorder (iRBD) (prodromal PD) and established PD. METHODS We recruited 11 iRBD and 15 patients with idiopathic PD (Hohen&Yahr 1-3, on L-DOPA and dopamine agonists combination therapy) and 12 age- and sex-matched controls (CTRL). We measured total olfactory score (TOS), autonomic function [deep breathing (DB), lying to standing (LS) and Valsalva manoeuvre (VM) ratios], blood reduced glutathione (Br-GSH), oxidative stress and inflammatory markers (neopterin). RESULTS Anosmia was similarly prevalent in iRBD (36%) and PD (33%) patients, but absent in CTRL. Orthostatic hypotension was more common among iRBD (73%) and PD (60%) than in CTRL (25%). By univariable ordinal logistic regression, TOS, Br-GSH, LS and VM ratio worsened from CTRL to iRBD and PD groups. Only reduced Br-GSH levels (p=0.037, OR=0.994; 95%CI 0.988-1.000) were independently associated to PD. TOS correlated with Br-GSH (R=0.34, p=0.037), VM ratio (R=0.43, p=0.015), and neopterin (rho=0.39, p=0.016). CONCLUSIONS Reduced systemic antioxidant capacity is found in prodromal and overt PD and may represent, in association with olfactory loss and cardiovascular dysautonomia, a useful biomarker for an integrative, early diagnosis of PD.
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Affiliation(s)
- Jonica Campolo
- CNR Institute of Clinical Physiology, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Renata De Maria
- CNR Institute of Clinical Physiology, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy.
| | - Lorena Cozzi
- CNR Institute of Clinical Physiology, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Marina Parolini
- CNR Institute of Clinical Physiology, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Stefano Bernardi
- CNR Institute of Clinical Physiology, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Paola Proserpio
- Epilepsy Surgery Centre, Centre of Sleep Medicine, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Lino Nobili
- Epilepsy Surgery Centre, Centre of Sleep Medicine, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Giorgio Gelosa
- Neurology and Stoke Unit, Department of Neuroscience, ASST-Great Metropolitan Hospital Niguarda, Milan, Italy
| | | | - Elio C Agostoni
- Neurology and Stoke Unit, Department of Neuroscience, ASST-Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Maria G Trivella
- CNR Institute of Clinical Physiology, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Paolo Marraccini
- CNR Institute of Clinical Physiology, ASST- Great Metropolitan Hospital Niguarda, Milan, Italy
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Costa A, Bosone D, Ramusino MC, Ghiotto N, Guaschino E, Zoppi A, D'Angelo A, Fogari R. Twenty-four-hour blood pressure profile, orthostatic hypotension, and cardiac dysautonomia in elderly type 2 diabetic hypertensive patients. Clin Auton Res 2016; 26:433-439. [PMID: 27624333 DOI: 10.1007/s10286-016-0381-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 03/14/2016] [Accepted: 07/24/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to evaluate the relationship between orthostatic hypotension (OH), defined as a decrease in systolic blood pressure (SBP) ≥20 mmHg and/or a decrease in diastolic blood pressure (DBP) ≥10 mmHg, and 24-h ambulatory BP profile in elderly hypertensive type 2 diabetic patients. METHODS After a 2-week antihypertensive wash-out period, 200 hypertensive well-controlled diabetic outpatients, aged 65-75 years, underwent a clinical examination, including BP measurements, ECG, 24-h ABP monitoring (ABPM), an orthostatic test, and three tests for cardiovascular autonomic function assessment [deep breathing, heart rate (HR) variability, resting HR]. RESULTS According to their nighttime BP profile, patients were divided into three groups: dippers (n = 86) (BP fall during nighttime ≥10 %), non-dippers (n = 80) (BP fall during nighttime 0-10 %), and reverse dippers (n = 34) (nighttime BP > daytime BP). Orthostatic test produced a significantly greater orthostatic SBP fall in dippers and even more in reverse dippers. In these latter, a significant fall was observed also in DBP. Prevalence of OH was 9.3 % in dippers, 30 % in non-dippers, and 79.4 % in reverse dippers. CONCLUSIONS In elderly hypertensive type 2 diabetics, a blunted nocturnal BP fall is associated with OH and autonomic dysfunction. These data suggest that ABPM should be performed in the assessment of hypertensive diabetic patients in whom the cardiovascular dysautonomia is suspected or the signs of it are present (such as OH).
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Affiliation(s)
- Alfredo Costa
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy
| | - Daniele Bosone
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy
| | - Matteo Cotta Ramusino
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy
| | - Natascia Ghiotto
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy
| | - Elena Guaschino
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy
| | - Annalisa Zoppi
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy
| | - Angela D'Angelo
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy
| | - Roberto Fogari
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy.
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