Machine learning applied to ambulatory blood pressure monitoring: a new tool to diagnose autonomic failure?
Autonomic failure prediction
Linear discriminant analysis
Supervised learning
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
Jul 2022
Jul 2022
Historique:
received:
09
10
2021
accepted:
08
02
2022
revised:
08
02
2022
pubmed:
23
2
2022
medline:
25
6
2022
entrez:
22
2
2022
Statut:
ppublish
Résumé
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. 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. 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. 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%). 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.
Sections du résumé
BACKGROUND
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
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 35192033
doi: 10.1007/s00415-022-11020-2
pii: 10.1007/s00415-022-11020-2
pmc: PMC9217832
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3833-3840Informations de copyright
© 2022. The Author(s).
Références
Vallelonga F, Di Stefano C, Merola A et al (2019) Blood pressure circadian rhythm alterations in alpha-synucleinopathies. J Neurol 266:1141–1152. https://doi.org/10.1007/s00415-019-09244-w
doi: 10.1007/s00415-019-09244-w
pubmed: 30783749
Palma J-A, Gomez-Esteban JC, Norcliffe-Kaufmann L et al (2015) Orthostatic hypotension in Parkinson disease: how much you fall or how low you go? Mov Disord 30:639–645. https://doi.org/10.1002/mds.26079
doi: 10.1002/mds.26079
pubmed: 25678194
pmcid: 4397106
Fanciulli A, Jordan J, Biaggioni I et al (2018) Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS): endorsed by the European Academy of Neurology (E. Clin Auton Res 28:355–362. https://doi.org/10.1007/s10286-018-0529-8
doi: 10.1007/s10286-018-0529-8
pubmed: 29766366
pmcid: 6097730
Palma JA, Redel-Traub G, Porciuncula A et al (2020) The impact of supine hypertension on target organ damage and survival in patients with synucleinopathies and neurogenic orthostatic hypotension. Parkinsonism Relat Disord 75:97–104. https://doi.org/10.1016/j.parkreldis.2020.04.011
doi: 10.1016/j.parkreldis.2020.04.011
pubmed: 32516630
pmcid: 7415666
Merola A, Romagnolo A, Rosso M et al (2018) Autonomic dysfunction in Parkinson’s disease: a prospective cohort study. Mov Disord 33:391–397. https://doi.org/10.1002/mds.27268
doi: 10.1002/mds.27268
pubmed: 29278286
Merola A, Romagnolo A, Rosso M et al (2016) Orthostatic hypotension in Parkinson’s disease: does it matter if asymptomatic? Parkinsonism Relat Disord 33:65–71. https://doi.org/10.1016/j.parkreldis.2016.09.013
doi: 10.1016/j.parkreldis.2016.09.013
pubmed: 27641792
De Pablo-Fernandez E, Tur C, Revesz T et al (2017) Association of autonomic dysfunction with disease progression and survival in Parkinson disease. JAMA Neurol 74:970–976. https://doi.org/10.1001/jamaneurol.2017.1125
doi: 10.1001/jamaneurol.2017.1125
pubmed: 28655059
pmcid: 5710320
Gibbons CH, Chawla JP, Cheshire WP et al (2017) Proper performance of autonomic function testing. Muscle Nerve 55:3–4. https://doi.org/10.1002/mus.25446
Milazzo V, Di Stefano C, Vallelonga F et al (2018) Reverse blood pressure dipping as marker of dysautonomia in Parkinson disease. Park Relat Disord 56:82–87. https://doi.org/10.1016/j.parkreldis.2018.06.032
doi: 10.1016/j.parkreldis.2018.06.032
Lodhi HA, Peri-Okonny PA, Schesing K et al (2019) Lodhi 2019 Usefulness of BP variability indices derived from 24-hour ABPM in detecting autonomic failure. J Am Hear Assoc 8(7):e010161
doi: 10.1161/JAHA.118.010161
Berardelli A, Wenning GK, Antonini A et al (2013) EFNS/MDS-ES recommendations for the diagnosis of Parkinson’s disease. Eur J Neurol 20:16–34. https://doi.org/10.1111/ene.12022
doi: 10.1111/ene.12022
pubmed: 23279440
Dineen J, Freeman R (2015) Autonomic neuropathy. Semin Neurol 35:458–468. https://doi.org/10.1055/s-0035-1558983
doi: 10.1055/s-0035-1558983
pubmed: 26502768
Dalrymple-Alford JC, MacAskill MR, Nakas CT et al (2010) The MoCA: well-suited screen for cognitive impairment in Parkinson disease. Neurology 75:1717–1725. https://doi.org/10.1212/WNL.0b013e3181fc29c9
doi: 10.1212/WNL.0b013e3181fc29c9
pubmed: 21060094
Low PA (1993) Composite autonomic scoring scale for laboratory quantification of generalized autonomic failure. Mayo Clin Proc 68:748–752. https://doi.org/10.1016/S0025-6196(12)60631-4
doi: 10.1016/S0025-6196(12)60631-4
pubmed: 8392653
Low PA, Denq JC, Opfer-Gehrking TL et al (1997) Effect of age and gender on sudomotor and cardiovagal function and blood pressure response to tilt in normal subjects. Muscle Nerve 20:1561–1568. https://doi.org/10.1002/(SICI)1097-4598(199712)20:12%3c1561::AID-MUS11%3e3.0.CO;2-3
doi: 10.1002/(SICI)1097-4598(199712)20:12<1561::AID-MUS11>3.0.CO;2-3
pubmed: 9390669
Freeman R, Wieling W, Axelrod FB et al (2011) Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res Off J Clin Auton Res Soc 21:69–72. https://doi.org/10.1007/s10286-011-0119-5
doi: 10.1007/s10286-011-0119-5
Parati G, Stergiou G, O’Brien E et al (2014) European society of hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens 32:1359–1366. https://doi.org/10.1097/HJH.0000000000000221
doi: 10.1097/HJH.0000000000000221
pubmed: 24886823
Bilo G, Giglio A, Styczkiewicz K et al (2007) A new method for assessing 24-h blood pressure variability after excluding the contribution of nocturnal blood pressure fall. J Hypertens 25:2058–2066. https://doi.org/10.1097/HJH.0b013e32829c6a60
doi: 10.1097/HJH.0b013e32829c6a60
pubmed: 17885548
Jansen RW, Lipsitz LA (1995) Postprandial hypotension: epidemiology, pathophysiology, and clinical management. Ann Intern Med 122:286–295. https://doi.org/10.7326/0003-4819-122-4-199502150-00009
doi: 10.7326/0003-4819-122-4-199502150-00009
pubmed: 7825766
Vallelonga F, Romagnolo A, Merola A et al (2019) Detection of orthostatic hypotension with ambulatory blood pressure monitoring in parkinson’s disease. Hypertens Res 42:1552–1560. https://doi.org/10.1038/s41440-019-0267-x
doi: 10.1038/s41440-019-0267-x
pubmed: 31118487
Burrello J, Burrello A, Stowasser M et al (2020) The primary aldosteronism surgical outcome score for the prediction of clinical outcomes after adrenalectomy for unilateral primary aldosteronism. Ann Surg 272:1125–1132. https://doi.org/10.1097/SLA.0000000000003200
doi: 10.1097/SLA.0000000000003200
pubmed: 30672800
Meyer LS, Wang X, Sušnik E et al (2018) Immunohistopathology and steroid profiles associated with biochemical outcomes after adrenalectomy for unilateral primary aldosteronism. Hypertens (Dallas, Tex) 72:650–657. https://doi.org/10.1161/HYPERTENSIONAHA.118.11465
doi: 10.1161/HYPERTENSIONAHA.118.11465
Tomlinson CL, Stowe R, Patel S et al (2010) Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord 25:2649–2653. https://doi.org/10.1002/mds.23429
doi: 10.1002/mds.23429
pubmed: 21069833
Di Stefano C, Sobrero G, Milazzo V et al (2020) Cardiac organ damage in patients with Parkinson’s disease and reverse dipping. J Hypertens 38:289–294. https://doi.org/10.1097/HJH.0000000000002249
doi: 10.1097/HJH.0000000000002249
pubmed: 31568061
Milazzo V, Di Stefano C, Milan A et al (2015) Cardiovascular complications in patients with autonomic failure. Clin Auton Res Off J Clin Auton Res Soc 25:133–140. https://doi.org/10.1007/s10286-015-0275-0
doi: 10.1007/s10286-015-0275-0
Vallelonga F, Maule S (2019) Diagnostic and therapeutical management of supine hypertension in autonomic failure: a review of the literature. J Hypertens 37:1102–1111. https://doi.org/10.1097/HJH.0000000000002008
doi: 10.1097/HJH.0000000000002008
pubmed: 30672835
Espay AJ, LeWitt PA, Hauser RA et al (2016) Neurogenic orthostatic hypotension and supine hypertension in Parkinson’s disease and related synucleinopathies: prioritisation of treatment targets. Lancet Neurol 15:954–966. https://doi.org/10.1016/S1474-4422(16)30079-5
doi: 10.1016/S1474-4422(16)30079-5
pubmed: 27478953