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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2001 Mar;70(3):305–310. doi: 10.1136/jnnp.70.3.305

Ambulatory ECG and analysis of heart rate variability in Parkinson's disease

T Haapaniemi 1, V Pursiainen 1, J Korpelainen 1, H Huikuri 1, K Sotaniemi 1, V Myllyla 1
PMCID: PMC1737270  PMID: 11181850

Abstract

OBJECTIVES—Cardiovascular reflex tests have shown both sympathetic and parasympathetic failure in Parkinson's disease. These tests, however, describe the autonomic responses during a restricted time period and have great individual variability, providing a limited view of the autonomic cardiac control mechanisms. Thus, they do not reflect tonic autonomic regulation. The aim was to examine tonic autonomic cardiovascular regulation in untreated patients with Parkinson's disease.
METHODS—24 Hour ambulatory ECG was recorded in 54 untreated patients with Parkinson's disease and 47 age matched healthy subjects. In addition to the traditional spectral (very low frequency, VLF; low frequency, LF; high frequency, HF) and non-spectral components of heart rate variability, instantaneous beat to beat variability (SD1) and long term continuous variability (SD2) derived from Poincaré plots, and the slope of the power law relation were analysed.
RESULTS—All spectral components (p<0.01) and the slope of the power-law relation (p<0.01) were lower in the patients with Parkinson's disease than in the control subjects. The Unified Parkinson's disease rating scale total and motor scores had a negative correlation with VLF and LF power spectrum values and the power law relation slopes. Patients with mild hypokinesia had higher HF values than patients with more severe hypokinesia. Tremor and rigidity were not associated with the HR variability parameters.
CONCLUSIONS—Parkinson's disease causes dysfunction of the diurnal autonomic cardiovascular regulation as demonstrated by the spectral measures of heart rate variability and the slope of the power law relation. This dysfunction seems to be more profound in patients with more severe Parkinson's disease.



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Selected References

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  1. Bigger J. T., Jr, Fleiss J. L., Steinman R. C., Rolnitzky L. M., Kleiger R. E., Rottman J. N. Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation. 1992 Jan;85(1):164–171. doi: 10.1161/01.cir.85.1.164. [DOI] [PubMed] [Google Scholar]
  2. Bigger J. T., Jr, Steinman R. C., Rolnitzky L. M., Fleiss J. L., Albrecht P., Cohen R. J. Power law behavior of RR-interval variability in healthy middle-aged persons, patients with recent acute myocardial infarction, and patients with heart transplants. Circulation. 1996 Jun 15;93(12):2142–2151. doi: 10.1161/01.cir.93.12.2142. [DOI] [PubMed] [Google Scholar]
  3. Brouwer J., van Veldhuisen D. J., Man in 't Veld A. J., Haaksma J., Dijk W. A., Visser K. R., Boomsma F., Dunselman P. H. Prognostic value of heart rate variability during long-term follow-up in patients with mild to moderate heart failure. The Dutch Ibopamine Multicenter Trial Study Group. J Am Coll Cardiol. 1996 Nov 1;28(5):1183–1189. doi: 10.1016/s0735-1097(96)00279-3. [DOI] [PubMed] [Google Scholar]
  4. Chipps D. R., Kraegen E. W., Zelenka G. S., McNamara M. E., Chisholm D. J. Cardiac beat to beat variation: age related changes in the normal population and abnormalities in diabetics. Aust N Z J Med. 1981 Dec;11(6):614–620. doi: 10.1111/j.1445-5994.1981.tb03535.x. [DOI] [PubMed] [Google Scholar]
  5. Denton T. A., Diamond G. A., Helfant R. H., Khan S., Karagueuzian H. Fascinating rhythm: a primer on chaos theory and its application to cardiology. Am Heart J. 1990 Dec;120(6 Pt 1):1419–1440. doi: 10.1016/0002-8703(90)90258-y. [DOI] [PubMed] [Google Scholar]
  6. Eckberg D. L. Sympathovagal balance: a critical appraisal. Circulation. 1997 Nov 4;96(9):3224–3232. doi: 10.1161/01.cir.96.9.3224. [DOI] [PubMed] [Google Scholar]
  7. Farrell T. G., Bashir Y., Cripps T., Malik M., Poloniecki J., Bennett E. D., Ward D. E., Camm A. J. Risk stratification for arrhythmic events in postinfarction patients based on heart rate variability, ambulatory electrocardiographic variables and the signal-averaged electrocardiogram. J Am Coll Cardiol. 1991 Sep;18(3):687–697. doi: 10.1016/0735-1097(91)90791-7. [DOI] [PubMed] [Google Scholar]
  8. Goldberger A. L. Non-linear dynamics for clinicians: chaos theory, fractals, and complexity at the bedside. Lancet. 1996 May 11;347(9011):1312–1314. doi: 10.1016/s0140-6736(96)90948-4. [DOI] [PubMed] [Google Scholar]
  9. Goldstein D. S., Holmes C., Cannon R. O., 3rd, Eisenhofer G., Kopin I. J. Sympathetic cardioneuropathy in dysautonomias. N Engl J Med. 1997 Mar 6;336(10):696–702. doi: 10.1056/NEJM199703063361004. [DOI] [PubMed] [Google Scholar]
  10. Gross M., Bannister R., Godwin-Austen R. Orthostatic hypotension in Parkinson's disease. Lancet. 1972 Jan 22;1(7743):174–176. doi: 10.1016/s0140-6736(72)90571-5. [DOI] [PubMed] [Google Scholar]
  11. Ho K. K., Moody G. B., Peng C. K., Mietus J. E., Larson M. G., Levy D., Goldberger A. L. Predicting survival in heart failure case and control subjects by use of fully automated methods for deriving nonlinear and conventional indices of heart rate dynamics. Circulation. 1997 Aug 5;96(3):842–848. doi: 10.1161/01.cir.96.3.842. [DOI] [PubMed] [Google Scholar]
  12. Hoehn M. M., Yahr M. D. Parkinsonism: onset, progression and mortality. Neurology. 1967 May;17(5):427–442. doi: 10.1212/wnl.17.5.427. [DOI] [PubMed] [Google Scholar]
  13. Huikuri H. V. Heart rate variability in coronary artery disease. J Intern Med. 1995 Apr;237(4):349–357. doi: 10.1111/j.1365-2796.1995.tb01186.x. [DOI] [PubMed] [Google Scholar]
  14. Huikuri H. V., Kessler K. M., Terracall E., Castellanos A., Linnaluoto M. K., Myerburg R. J. Reproducibility and circadian rhythm of heart rate variability in healthy subjects. Am J Cardiol. 1990 Feb 1;65(5):391–393. doi: 10.1016/0002-9149(90)90308-n. [DOI] [PubMed] [Google Scholar]
  15. Huikuri H. V., Mäkikallio T. H., Airaksinen K. E., Seppänen T., Puukka P., Räihä I. J., Sourander L. B. Power-law relationship of heart rate variability as a predictor of mortality in the elderly. Circulation. 1998 May 26;97(20):2031–2036. doi: 10.1161/01.cir.97.20.2031. [DOI] [PubMed] [Google Scholar]
  16. Jellinger K. A. Post mortem studies in Parkinson's disease--is it possible to detect brain areas for specific symptoms? J Neural Transm Suppl. 1999;56:1–29. doi: 10.1007/978-3-7091-6360-3_1. [DOI] [PubMed] [Google Scholar]
  17. Kleiger R. E., Miller J. P., Bigger J. T., Jr, Moss A. J. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987 Feb 1;59(4):256–262. doi: 10.1016/0002-9149(87)90795-8. [DOI] [PubMed] [Google Scholar]
  18. Korpelainen J. T., Sotaniemi K. A., Huikuri H. V., Myllyä V. V. Abnormal heart rate variability as a manifestation of autonomic dysfunction in hemispheric brain infarction. Stroke. 1996 Nov;27(11):2059–2063. doi: 10.1161/01.str.27.11.2059. [DOI] [PubMed] [Google Scholar]
  19. Korpelainen J. T., Sotaniemi K. A., Mäkikallio A., Huikuri H. V., Myllylä V. V. Dynamic behavior of heart rate in ischemic stroke. Stroke. 1999 May;30(5):1008–1013. doi: 10.1161/01.str.30.5.1008. [DOI] [PubMed] [Google Scholar]
  20. Kuroiwa Y., Shimada Y., Toyokura Y. Postural hypotension and low R-R interval variability in parkinsonism, spino-cerebellar degeneration, and Shy-Drager syndrome. Neurology. 1983 Apr;33(4):463–467. doi: 10.1212/wnl.33.4.463. [DOI] [PubMed] [Google Scholar]
  21. Ludin S. M., Steiger U. H., Ludin H. P. Autonomic disturbances and cardiovascular reflexes in idiopathic Parkinson's disease. J Neurol. 1987 Oct;235(1):10–15. doi: 10.1007/BF00314190. [DOI] [PubMed] [Google Scholar]
  22. Madwed J. B., Albrecht P., Mark R. G., Cohen R. J. Low-frequency oscillations in arterial pressure and heart rate: a simple computer model. Am J Physiol. 1989 Jun;256(6 Pt 2):H1573–H1579. doi: 10.1152/ajpheart.1989.256.6.H1573. [DOI] [PubMed] [Google Scholar]
  23. Massetani R., Strata G., Galli R., Gori S., Gneri C., Limbruno U., Di Santo D., Mariani M., Murri L. Alteration of cardiac function in patients with temporal lobe epilepsy: different roles of EEG-ECG monitoring and spectral analysis of RR variability. Epilepsia. 1997 Mar;38(3):363–369. doi: 10.1111/j.1528-1157.1997.tb01129.x. [DOI] [PubMed] [Google Scholar]
  24. Mastrocola C., Vanacore N., Giovani A., Locuratolo N., Vella C., Alessandri A., Baratta L., Tubani L., Meco G. Twenty-four-hour heart rate variability to assess autonomic function in Parkinson's disease. Acta Neurol Scand. 1999 Apr;99(4):245–247. doi: 10.1111/j.1600-0404.1999.tb07355.x. [DOI] [PubMed] [Google Scholar]
  25. Meco G., Pratesi L., Bonifati V. Cardiovascular reflexes and autonomic dysfunction in Parkinson's disease. J Neurol. 1991 Jul;238(4):195–199. doi: 10.1007/BF00314779. [DOI] [PubMed] [Google Scholar]
  26. Mäkikallio T. H., Seppänen T., Niemelä M., Airaksinen K. E., Tulppo M., Huikuri H. V. Abnormalities in beat to beat complexity of heart rate dynamics in patients with a previous myocardial infarction. J Am Coll Cardiol. 1996 Oct;28(4):1005–1011. doi: 10.1016/s0735-1097(96)00243-4. [DOI] [PubMed] [Google Scholar]
  27. Novak V., Novak P., deMarchie M., Schondorf R. The effect of severe brainstem injury on heart rate and blood pressure oscillations. Clin Auton Res. 1995 Feb;5(1):24–30. doi: 10.1007/BF01845495. [DOI] [PubMed] [Google Scholar]
  28. Ori Z., Monir G., Weiss J., Sayhouni X., Singer D. H. Heart rate variability. Frequency domain analysis. Cardiol Clin. 1992 Aug;10(3):499–537. [PubMed] [Google Scholar]
  29. Orimo S., Ozawa E., Nakade S., Sugimoto T., Mizusawa H. (123)I-metaiodobenzylguanidine myocardial scintigraphy in Parkinson's disease. J Neurol Neurosurg Psychiatry. 1999 Aug;67(2):189–194. doi: 10.1136/jnnp.67.2.189. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Pagani M., Montano N., Porta A., Malliani A., Abboud F. M., Birkett C., Somers V. K. Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans. Circulation. 1997 Mar 18;95(6):1441–1448. doi: 10.1161/01.cir.95.6.1441. [DOI] [PubMed] [Google Scholar]
  31. Pincus S. M., Goldberger A. L. Physiological time-series analysis: what does regularity quantify? Am J Physiol. 1994 Apr;266(4 Pt 2):H1643–H1656. doi: 10.1152/ajpheart.1994.266.4.H1643. [DOI] [PubMed] [Google Scholar]
  32. Pomeranz B., Macaulay R. J., Caudill M. A., Kutz I., Adam D., Gordon D., Kilborn K. M., Barger A. C., Shannon D. C., Cohen R. J. Assessment of autonomic function in humans by heart rate spectral analysis. Am J Physiol. 1985 Jan;248(1 Pt 2):H151–H153. doi: 10.1152/ajpheart.1985.248.1.H151. [DOI] [PubMed] [Google Scholar]
  33. Ravits J. M. AAEM minimonograph #48: autonomic nervous system testing. Muscle Nerve. 1997 Aug;20(8):919–937. doi: 10.1002/(sici)1097-4598(199708)20:8<919::aid-mus1>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  34. Rosenbaum M., Race D. Frequency-response characteristics of vascular resistance vessels. Am J Physiol. 1968 Dec;215(6):1397–1402. doi: 10.1152/ajplegacy.1968.215.6.1397. [DOI] [PubMed] [Google Scholar]
  35. Sega S., Jager F., Kiauta T. A comparison of cardiovascular reflex tests and spectral analysis of heart rate variability in healthy subjects. Clin Auton Res. 1993 Jun;3(3):175–182. doi: 10.1007/BF01826230. [DOI] [PubMed] [Google Scholar]
  36. Singer C., Weiner W. J., Sanchez-Ramos J. R. Autonomic dysfunction in men with Parkinson's disease. Eur Neurol. 1992;32(3):134–140. doi: 10.1159/000116810. [DOI] [PubMed] [Google Scholar]
  37. Tulppo M. P., Mäkikallio T. H., Takala T. E., Seppänen T., Huikuri H. V. Quantitative beat-to-beat analysis of heart rate dynamics during exercise. Am J Physiol. 1996 Jul;271(1 Pt 2):H244–H252. doi: 10.1152/ajpheart.1996.271.1.H244. [DOI] [PubMed] [Google Scholar]
  38. Turkka J. T., Tolonen U., Myllylä V. V. Cardiovascular reflexes in Parkinson's disease. Eur Neurol. 1987;26(2):104–112. doi: 10.1159/000116319. [DOI] [PubMed] [Google Scholar]
  39. Turkka J., Suominen K., Tolonen U., Sotaniemi K., Myllylä V. V. Selegiline diminishes cardiovascular autonomic responses in Parkinson's disease. Neurology. 1997 Mar;48(3):662–667. doi: 10.1212/wnl.48.3.662. [DOI] [PubMed] [Google Scholar]
  40. van Dijk J. G., Haan J., Zwinderman K., Kremer B., van Hilten B. J., Roos R. A. Autonomic nervous system dysfunction in Parkinson's disease: relationships with age, medication, duration, and severity. J Neurol Neurosurg Psychiatry. 1993 Oct;56(10):1090–1095. doi: 10.1136/jnnp.56.10.1090. [DOI] [PMC free article] [PubMed] [Google Scholar]

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