Cardiac Structure And Function In Parkinson’s Disease With Cardiac Autonomic Neuropathy

Purpose: Parkinson’s disease(PD)patients are prone to cardiac autonomic neuropathy(CAN),which was defined as impairment of autonomic control of cardiovascular system.However,the effect of cardiac autonomic neuropathy in PD on heart as a target organ was not fully understood.Evidence regarding the association between cardiac autonomic neuropathy in Parkinson’s disease and cardiac structural and functional alteration is limited.Thus,this study aimed to investigate the cardiac structural and functional alteration in patients with Parkinson’s disease with cardiac autonomic neuropathy(PD-CAN)and explore the correlation between CAN and cardiac structural and functional alteration.Methods: This cross-sectional study was conducted between November 2020 and February 2022 in Guangdong Provincial People’s Hospital.Clinical and autonomic evaluation had been performed in all subjects.Cardiac autonomic neuropathy was defined as a score of at least four points or presence of orthostatic hypotension in Cardiovascular Autonomic Reflex Tests(CARTs).Global cardiac structure,systolic and diastolic function were evaluated with echocardiography and 2D-speckle tracking echocardiography,respectively.Special pattern of cardiac changes of PD-CAN patients and the potential relationship between CAN and cardiac structure and function would be investigated.This study was registered on Chinese Clinical Trial Registry(Chi CTR2000039475).Results: A total of 20 PD-CAN patients,33 PD patients without CAN(PD-n CAN),and 23 health controls(HC)were included.Left ventricular mass index(LVMI)was higher in PD-CAN compared with HC(90.31±11.35 vs.77.48±17.82,p=0.019),which remained significant after adjusting for age and history of hypertension(HTN)as covariates.Worsening of systolic parameters including decreasing left ventricular global longitudinal strain(LV-GLS)(-19.14±1.93 vs.-21.34±2.02 vs.-21.94±1.81,p<0.001)and systolic mitral annular velocity(s’)[7.35(6.5-8)vs.8(7.4-9.55)vs.8(7.3-8.6),p=0.041] was found in PD-CAN group in comparison with the PD-n CAN and HC group,reflecting predisposition to preclinical cardiac systolic dysfunction.Diastolic parameters including decreasing left atrial volume index(LAVI)(24±7.15 vs.17.75±4.48 vs.16.94±4.75,p<0.001)were also found worse in PD-CAN group compared with PD-n CAN group,reflecting predisposition to preclinical cardiac diastolic dysfunction.With age,history of hypertension(HTN)and body mass index(BMI)as covariates,multiple regression revealed that LV-GLS(β=0.560,p=0.001)and LAVI(β=0.328,p=0.048)were correlated with CARTs score,characterizing the relationship between worsening of parameters in LV systolic or diastolic function and severity of CAN.Conclusion: PD patients might develop preclinical left ventricular hypertrophy.PD-CAN patients are prone to preclinical cardiac systolic and diastolic dysfunction,in correlation with severity of CAN.