Orthostatic heart rate changes in patients with autonomic failure caused by neurodegenerative synucleinopathies

Abstract

A blunted HR increase during hypotension suggests a neurogenic cause. A ΔHR/ΔSBP ratio < 0.5 bpm/mmHg is diagnostic of neurogenic OH. Ann Neurol 2018;83:522-531.

Reply to validation of the new diagnostic tests for neurogenic orthostatic hypotension

“…1 Gender inequality is a long-standing problem in publication practices in general, 2 as well as in neurology, 3,4 academic medicine, 5 and science, 6 so it is not surprising to see it reflected in the field of multiple sclerosis (MS). 1 Gender inequality is a long-standing problem in publication practices in general, 2 as well as in neurology, 3,4 academic medicine, 5 and science, 6 so it is not surprising to see it reflected in the field of multiple sclerosis (MS).…”

“…We thank Moneim and colleagues for calling attention to the issue of gender inequality in MS clinical trial steering committees and in authorship on publications emerging from phase 3 clinical trials. 1 Gender inequality is a long-standing problem in publication practices in general, 2 as well as in neurology, 3,4 academic medicine, 5 and science, 6 so it is not surprising to see it reflected in the field of multiple sclerosis (MS). This occurs despite the availability of a substantial number of successful senior female academic neurologists and neuroscientists worldwide who have extensive experience in MS clinical and basic research methodology; some are cosigners of this letter.…”

“…1 Although this is a crucial first-line step in the diagnosis workup of a patient presenting with OH, most guidelines do not indicate a ΔHR threshold, whereas a recent consensus panel suggested a neurogenic cause of OH is supported by a ΔHR < 15 beats per minute (bpm). 1 Although this is a crucial first-line step in the diagnosis workup of a patient presenting with OH, most guidelines do not indicate a ΔHR threshold, whereas a recent consensus panel suggested a neurogenic cause of OH is supported by a ΔHR < 15 beats per minute (bpm).…”

“…Norcliffe-Kaufmann et al recently conducted a very interesting study to determine the optimal heart rate variation (ΔHR) threshold differentiating neurogenic from non-neurogenic orthostatic hypotension (OH). 1 Although this is a crucial first-line step in the diagnosis workup of a patient presenting with OH, most guidelines do not indicate a ΔHR threshold, whereas a recent consensus panel suggested a neurogenic cause of OH is supported by a ΔHR < 15 beats per minute (bpm). 2 In 378 patients with neurogenic OH (including 13 patients with pure autonomic failure) and 24 patients with non-neurogenic OH, the authors identified a ΔHR < 17bpm as having optimal sensitivity (79%) and specificity (87%).…”

A validated test for neurogenic orthostatic hypotension at the bedside

“…We read with interest the small study by Balagny and colleagues, performed in response to our publication on the orthostatic heart rate (HR) and blood pressure (BP) changes in the diagnosis of neurogenic orthostatic hypotension . Our study, which was a multicenter collaboration within the Autonomic Disorders Consortium, showed that a rise in HR of <0.49 beats/min per mmHg of systolic BP fall provided optimal sensitivity and specificity to identify patients with structural lesions within the baroreflex arch and to distinguish them from those with hypotension due to dehydration or polypharmacy or both.…”