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Article ; Online: Correction to: Autonomic function test during the COVID‑19 pandemic: is it safe and sound?

Guaraldi, Pietro

Clinical autonomic research : official journal of the Clinical Autonomic Research Society

2021 Volume 31, Issue 6, Page(s) 799

Language	English
Publishing date	2021-08-06
Publishing country	Germany
Document type	Published Erratum
ZDB-ID	1080007-4
ISSN	1619-1560 ; 0959-9851
ISSN (online)	1619-1560
ISSN	0959-9851
DOI	10.1007/s10286-021-00821-6
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Article ; Online: Autonomic function test during the COVID-19 pandemic: is it safe and sound?

Guaraldi, Pietro

Clinical autonomic research : official journal of the Clinical Autonomic Research Society

2021 Volume 31, Issue 1, Page(s) 57–58

MeSH term(s)	Autonomic Nervous System Diseases/diagnosis ; Autonomic Nervous System Diseases/epidemiology ; COVID-19/epidemiology ; COVID-19/prevention & control ; Health Personnel/standards ; Humans ; Pandemics/prevention & control ; Personal Protective Equipment/standards ; Practice Guidelines as Topic/standards
Language	English
Publishing date	2021-02-02
Publishing country	Germany
Document type	Editorial
ZDB-ID	1080007-4
ISSN	1619-1560 ; 0959-9851
ISSN (online)	1619-1560
ISSN	0959-9851
DOI	10.1007/s10286-021-00776-8
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Article ; Online: Levodopa-induced orthostatic hypotension in parkinsonism: A red flag of autonomic failure.

Cani, Ilaria / Guaraldi, Pietro / Giannini, Giulia / Sambati, Luisa / Barletta, Giorgio / Cortelli, Pietro / Calandra-Buonaura, Giovanna

European journal of neurology

2023 Volume 31, Issue 1, Page(s) e16061

Abstract: Background and purpose: Levodopa (LD) is the main treatment for parkinsonism, but its use may be limited by a potential hypotensive effect.: Methods: We evaluated the cardiovascular effect of LD performing head-up tilt test (HUTT) before and 60 min ... ...

Abstract	Background and purpose: Levodopa (LD) is the main treatment for parkinsonism, but its use may be limited by a potential hypotensive effect. Methods: We evaluated the cardiovascular effect of LD performing head-up tilt test (HUTT) before and 60 min after 100/25 mg LD/dopa-decarboxylase inhibitor (pre-LD vs. post-LD HUTT) in 164 patients with parkinsonism on chronic LD treatment. Features predictive of LD-induced orthostatic hypotension (OH) were assessed by logistic regression analysis. Results: Basal supine blood pressure (BP) and heart rate (HR) decreased after LD. During post-LD HUTT, BP drop and HR increase were significantly greater than at pre-LD HUTT. Thirty-eight percent of patients had OH at post-LD HUTT compared to 22% of patients presenting OH at pre-LD HUTT (p < 0.001). Risk factors for LD-induced/worsened OH were pre-LD OH (odds ratio [OR] = 36, 95% confidence interval [CI] = 10-131), absence of overshoot at Valsalva maneuver (OR = 9, 95% CI = 4-20), and pathological Valsalva ratio (OR = 6, 95% CI = 2-15). Conclusions: LD administration caused/worsened hypotension in both supine and orthostatic conditions. Patients with cardiovascular autonomic failure had a higher risk of developing LD-induced OH. In clinical practice, LD-induced OH could represent a red flag for cardiovascular autonomic failure.
MeSH term(s)	Humans ; Hypotension, Orthostatic/drug therapy ; Levodopa/adverse effects ; Blood Pressure/physiology ; Heart ; Parkinsonian Disorders ; Tilt-Table Test/adverse effects ; Heart Rate
Chemical Substances	Levodopa (46627O600J)
Language	English
Publishing date	2023-09-19
Publishing country	England
Document type	Journal Article
ZDB-ID	1280785-0
ISSN	1468-1331 ; 1351-5101 ; 1471-0552
ISSN (online)	1468-1331
ISSN	1351-5101 ; 1471-0552
DOI	10.1111/ene.16061
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Zs.A 4738: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 592: Show issues

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Article ; Online: The Degree of Cardiovascular Autonomic Dysfunction is not Different in GBA-Related and Idiopathic Parkinson's Disease Patients: A Case-Control Instrumental Evaluation.

Giannini, Giulia / Minardi, Raffaella / Barletta, Giorgio / Cani, Ilaria / Cecere, Annagrazia / Baldelli, Luca / Fiorentino, Alessia / Guaraldi, Pietro / Sambati, Luisa / Capellari, Sabina / Cortelli, Pietro / Carelli, Valerio / Calandra-Buonaura, Giovanna

Journal of Parkinson's disease

2024 Volume 14, Issue 2, Page(s) 335–346

Abstract: Background: Increased prevalence of cardiovascular autonomic failure might play a key role on Parkinson's disease (PD) progression of glucocerebrosidase gene (GBA)-mutated patients, determining a malignant phenotype of disease in these patients.: ... ...

Abstract	Background: Increased prevalence of cardiovascular autonomic failure might play a key role on Parkinson's disease (PD) progression of glucocerebrosidase gene (GBA)-mutated patients, determining a malignant phenotype of disease in these patients. Objective: To objectively characterize, for the first time, the cardiovascular autonomic profile of GBA-mutated patients compared to idiopathic PD patients by means of cardiovascular reflex tests (CRTs). Methods: This is a case-control (1 : 2) study on PD patients belonging to well-characterized prospective cohorts. For each PD patient carrying GBA variants, two idiopathic PD patients, matched for sex and disease duration at CRTs, were selected. Patients recruited in these cohorts underwent a complete clinical and instrumental evaluation including specific autonomic questionnaires, CRTs and extensive genetic analysis. Results: A total of 23 GBA-PD patients (19 males, disease duration 7.7 years) were included and matched with 46 non-mutated PD controls. GBA-mutated patients were younger than controls (59.9±8.1 vs. 64.3±7.2 years, p = 0.0257) and showed a more severe phenotype. Despite GBA-mutated patients reported more frequently symptoms suggestive of orthostatic hypotension (OH) than non-mutated patients (39.1% vs 6.5%, p = 0.001), the degree of cardiovascular autonomic dysfunction, when instrumentally assessed, did not differ between the two groups, showing the same prevalence of neurogenic OH, delayed OH and cardiovascular reflex impairment (pathological Valsalva maneuver). Conclusion: GBA-PD patients did not show different instrumental cardiovascular autonomic pattern than non-mutated PD. Our findings suggested that symptoms suggestive of OH should be promptly investigated by clinicians to confirm their nature and improve patient care and management.
MeSH term(s)	Humans ; Male ; Autonomic Nervous System Diseases/diagnosis ; Autonomic Nervous System Diseases/etiology ; Case-Control Studies ; Glucosylceramidase/genetics ; Hypotension, Orthostatic ; Mutation ; Parkinson Disease/complications ; Parkinson Disease/genetics ; Prospective Studies
Chemical Substances	Glucosylceramidase (EC 3.2.1.45) ; GBA protein, human (EC 3.2.1.45)
Language	English
Publishing date	2024-02-02
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2620609-2
ISSN	1877-718X ; 1877-7171
ISSN (online)	1877-718X
ISSN	1877-7171
DOI	10.3233/JPD-230334
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Zs.A 6964: Show issues

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Article ; Online: Role of Thalamus in Sleep-Wake Cycle Regulation.

Guaraldi, Pietro / Calandra-Buonaura, Giovanna / Provini, Federica / Cortelli, Pietro

Annals of neurology

2019 Volume 85, Issue 4, Page(s) 611

MeSH term(s)	Arousal ; Brain Stem ; Humans ; Stroke ; Thalamus
Language	English
Publishing date	2019-03-11
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	80362-5
ISSN	1531-8249 ; 0364-5134
ISSN (online)	1531-8249
ISSN	0364-5134
DOI	10.1002/ana.25449
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Zs.A 1370: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 478: Show issues

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Article: Epigenetic clocks suggest accelerated aging in patients with isolated REM Sleep Behavior Disorder.

Baldelli, Luca / Pirazzini, Chiara / Sambati, Luisa / Ravaioli, Francesco / Gentilini, Davide / Calandra-Buonaura, Giovanna / Guaraldi, Pietro / Franceschi, Claudio / Cortelli, Pietro / Garagnani, Paolo / Bacalini, Maria Giulia / Provini, Federica

NPJ Parkinson's disease

2023 Volume 9, Issue 1, Page(s) 48

Abstract: Isolated REM Sleep Behavior Disorder (iRBD) is the strongest prodromal marker for α-synucleinopathies. Overt α-synucleinopathies and aging share several mechanisms, but this relationship has been poorly investigated in prodromal phases. Using DNA ... ...

Abstract	Isolated REM Sleep Behavior Disorder (iRBD) is the strongest prodromal marker for α-synucleinopathies. Overt α-synucleinopathies and aging share several mechanisms, but this relationship has been poorly investigated in prodromal phases. Using DNA methylation-based epigenetic clocks, we measured biological aging in videopolysomnography confirmed iRBD patients, videopolysomnography-negative and population-based controls. We found that iRBDs tended to be epigenetically older than controls, suggesting that accelerated aging characterizes prodromal neurodegeneration.
Language	English
Publishing date	2023-03-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2819218-7
ISSN	2373-8057
ISSN	2373-8057
DOI	10.1038/s41531-023-00492-2
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Article ; Online: Neurogenic orthostatic hypotension in early stage Parkinson's disease: New insights from the first 105 patients of the BoProPark study.

Baschieri, Francesca / Sambati, Luisa / Guaraldi, Pietro / Barletta, Giorgio / Cortelli, Pietro / Calandra-Buonaura, Giovanna

Parkinsonism & related disorders

2021 Volume 93, Page(s) 12–18

Abstract: Objectives: The prevalence of neurogenic orthostatic hypotension (NOH, due to cardiovascular autonomic failure) at early stage of Parkinson's disease (PD) is unknown. The aims of this study are to prospectively evaluate in a cohort of PD patients ... ...

Abstract	Objectives: The prevalence of neurogenic orthostatic hypotension (NOH, due to cardiovascular autonomic failure) at early stage of Parkinson's disease (PD) is unknown. The aims of this study are to prospectively evaluate in a cohort of PD patients recruited within 3 years from motor onset (1) cardiovascular autonomic functions by means of cardiovascular reflex tests (CRTs) and the occurrence of NOH; (2) the frequency of orthostatic symptoms with a validated questionnaire. Methods: We included the first 105 PD patients of the prospective "BoProPark" study. Each patient underwent CRTs (head up tilt test; Valsalva manoeuvre; deep breathing; cold face test and handgrip test) under continuous blood pressure monitoring according to standardized procedures and SCOPA-Aut questionnaire at baseline (T0) and after 16 months (T1). A group of 50 age- and sex-matched controls was used for comparison. Results: At T0 (mean age 61 ± 9 years, disease duration 19 ± 9 months) NOH was detected in 4/105 (3.8%) patients, whereas at T1 in 8/105 (7.6%). CRTs responses assessing sympathetic function were impaired at T0 in PD patients compared to controls and progressively worsened at T1. Only 1 patient at T0 and 3 at T1 with NOH reported orthostatic symptoms with low frequency, while the majority of patients reporting these symptoms did not have OH at testing. Conclusions: Our prospective study shows that NOH is not common at early PD stage. Asymptomatic mild sympathetic impairment was observed at first evaluation and progressed with disease evolution. Secondary OH may account for the higher prevalence of OH in PD reported so far.
MeSH term(s)	Aged ; Blood Pressure ; Female ; Hand Strength ; Humans ; Hypotension, Orthostatic/diagnosis ; Hypotension, Orthostatic/etiology ; Male ; Middle Aged ; Parkinson Disease/complications ; Parkinson Disease/diagnosis ; Prospective Studies ; Reflex ; Standing Position ; Tilt-Table Test ; Valsalva Maneuver
Language	English
Publishing date	2021-11-04
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	1311489-x
ISSN	1873-5126 ; 1353-8020
ISSN (online)	1873-5126
ISSN	1353-8020
DOI	10.1016/j.parkreldis.2021.11.002
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Zs.A 4553: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 420: Show issues

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Article ; Online: Characterization and natural history of different phenotypes in hereditary transthyretin amyloidosis: 40-year experience at a single Italian referral center.

Caponetti, Angelo Giuseppe / Sguazzotti, Maurizio / Accietto, Antonella / Saturi, Giulia / Ponziani, Alberto / Giovannetti, Alessandro / Massa, Paolo / Ruotolo, Irene / Sena, Giuseppe / Zaccaro, Andrea / Parisi, Vanda / Bonfiglioli, Rachele / Guaraldi, Pietro / Gagliardi, Christian / Cortelli, Pietro / Galie, Nazzareno / Biagini, Elena / Longhi, Simone

European journal of preventive cardiology

2024

Abstract: Aims: Hereditary Transthyretin Amyloidosis (ATTRv) is one of the leading etiologies of systemic amyloidosis with more than 135 mutations described and a broad spectrum of clinical manifestations. We aimed to provide a systematic description of a ... ...

Abstract	Aims: Hereditary Transthyretin Amyloidosis (ATTRv) is one of the leading etiologies of systemic amyloidosis with more than 135 mutations described and a broad spectrum of clinical manifestations. We aimed to provide a systematic description of a population of individuals carrying pathogenic mutations of transthyretin (TTR) gene and to investigate the major clinical events during follow up. Methods: Observational, retrospective, cohort study including consecutive patients with mutations of TTR gene, admitted to a tertiary referral center in Bologna, Italy, between 1984 and 2022. Results: Three hundred twenty-five patients were included: 106 asymptomatic carriers, 49 cardiac phenotype, 49 neurological phenotype and 121 mixed phenotype. Twenty-two different mutations were found, with Ile68Leu (41.8%), Val30Met (19%), and Glu89Gln (10%) being the most common. After a median follow-up of 51 months 111 patients (38.3%) died and nine (11.5%) of the 78 asymptomatic carriers developed ATTRv. Carriers had a prognosis comparable to healthy population, while no significant differences were seen among the three phenotypes adjusted by age. Age at diagnosis, NYHA class III, LVEF, mPND score IV and disease-modifying therapy were independently associated with survival. Conclusions: This study offers a wide and comprehensive overview of ATTRv from the point of view of a tertiary referral center in Italy. Three main phenotypes can be identified (cardiac, neurological and mixed) with specific clinical and instrumental features. Family screening programs are essential to identify paucisymptomatic affected patients or unaffected carriers of the mutation, to be followed through the years. Lastly, disease-modifying therapy represents an evolving cornerstone of the management of ATTRv, with a great impact on mortality.
Language	English
Publishing date	2024-01-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2626011-6
ISSN	2047-4881 ; 2047-4873
ISSN (online)	2047-4881
ISSN	2047-4873
DOI	10.1093/eurjpc/zwae011
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Zs.A 4686: Show issues

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Article ; Online: Effects of Spinal Cord Injury Site on Cardiac Autonomic Regulation: Insight from Analysis of Cardiovascular Beat by Beat Variability during Sleep and Orthostatic Challenge.

Guaraldi, Pietro / Malacarne, Mara / Barletta, Giorgio / Scisciolo, Giuseppe De / Pagani, Massimo / Cortelli, Pietro / Lucini, Daniela

Journal of functional morphology and kinesiology

2022 Volume 7, Issue 4

Abstract: Purpose: The goal of this study on Spinal Cord Injury (SCI) patients with cervical or thoracic lesion was to assess whether disturbances of ANS control, according to location, might differently affect vagal and sympatho-vagal markers during sleep and ... ...

Abstract	Purpose: The goal of this study on Spinal Cord Injury (SCI) patients with cervical or thoracic lesion was to assess whether disturbances of ANS control, according to location, might differently affect vagal and sympatho-vagal markers during sleep and orthostatic challenge. We analyzed with linear and nonlinear techniques beat-by-beat RR and arterial pressure (and respiration) variability signals, extracted from a polysomnographic study and a rest-tilt test. We considered spontaneous or induced sympathetic excitation, as obtained shifting from non-REM to REM sleep or from rest to passive tilt. We obtained evidence of ANS cardiac (dys)regulation, of greater importance for gradually proximal location (i.e., cervical) SCI, compatible with a progressive loss of modulatory role of sympathetic afferents to the spinal cord. Furthermore, in accordance with the dual, vagal and sympathetic bidirectional innervation, the results suggest that vagally mediated negative feedback baroreflexes were substantially maintained in all cases. Conversely, the LF and HF balance (expressed specifically by normalized units) appeared to be negatively affected by SCI, particularly in the case of cervical lesion (group
Language	English
Publishing date	2022-12-09
Publishing country	Switzerland
Document type	Journal Article
ISSN	2411-5142
ISSN (online)	2411-5142
DOI	10.3390/jfmk7040112
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Article ; Online: Testing cardiovascular autonomic function in the COVID-19 era: lessons from Bologna's Autonomic Unit.

Guaraldi, Pietro / Barletta, Giorgio / Baschieri, Francesca / Calandra-Buonaura, Giovanna / Provini, Federica / Cortelli, Pietro

Clinical autonomic research : official journal of the Clinical Autonomic Research Society

2020 Volume 30, Issue 4, Page(s) 325–330

Abstract: The coronavirus disease 2019 (COVID-19) pandemic has changed the way most medical procedures are performed. Autonomic units, as well as other healthcare sectors, are required to undergo a thorough reorganization of the protocols in order to guarantee the ...

Abstract	The coronavirus disease 2019 (COVID-19) pandemic has changed the way most medical procedures are performed. Autonomic units, as well as other healthcare sectors, are required to undergo a thorough reorganization of the protocols in order to guarantee the safety of patients and healthcare staff. Cardiovascular autonomic function testing (CAFT) is necessary in certain situations; however, it poses several concerns which need to be addressed. Here, we provide some practical advice based on current national and international health authorities' recommendations and our experience about how to perform CAFT during the COVID-19 emergency. We examine aspects regarding patients, healthcare staff, laboratory preparation, and test performance.
MeSH term(s)	Autonomic Nervous System/physiology ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Coronavirus Infections/physiopathology ; Diagnostic Techniques, Cardiovascular/standards ; Health Personnel/standards ; Humans ; Italy/epidemiology ; Pandemics ; Personal Protective Equipment/standards ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/physiopathology ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-07-13
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	1080007-4
ISSN	1619-1560 ; 0959-9851
ISSN (online)	1619-1560
ISSN	0959-9851
DOI	10.1007/s10286-020-00710-4
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