Objective: Studies have shown that autonomic nervous  symptoms precede motor symptoms in  PD, making autonomic function assessment a potential tool for early PD diagnosis. This study aims to evaluate cardiopulmonary coupling (CPC) as an objective and quantitative biomarker for early PD detection.

Background: Previous studies have found a significant association between heart rate variability parameters and disease duration. Additionally, respiratory symptoms emerge years before motor symptoms. Heart rate variability and respiration have shown some value in the early diagnosis of PD, their single-modality nature limits detection specificity and accuracy. CPC  analysis, which integrates heart rate and respiration, has recently gained attention  to autonomic nervous system assessment. We introduce a method that measures heart rate while controlling respiratory frequency, aiming to develop a simple and rapid tool for early PD detection.

Method: A total of 42 early-stage PD patients and 20 healthy controls were recruited. Single-lead electrocardiogram signals were recorded during respiratory control training: (1) 3-second inhalation followed by 2-second exhalation for 5 minutes and (2) 2-second inhalation followed by 3-second exhalation for 5 minutes.  Power spectral analysis and causal coupling analysis were applied to heart rate signals to compare CPC differences between PD patients and healthy controls.

Results: 1. The CPC index during the 3s-inhalation,2s-exhalation  exercise was negatively correlated with MDS-UPDRS scores (Rp = -0.61, P < 0.001) and was significantly lower than the CPC index during the 2s-inhalation,3s-exhalation exercise (P < 0.001).

2. During the 3s-inhalation, 2s-exhalation exercise, PD patients had a significantly lower CPC index compared to healthy controls (P < 0.001), whereas no significant difference was observed between the two groups during the 2s-inhalation, 3s-exhalation exercise (P = 0.67).

3. Power spectral analysis-based metrics achieved an accuracy of 0.93, with a sensitivity of 0.93 and a specificity of 0.95 for early PD detection.

Conclusion: Cardiopulmonary coupling analysis during respiratory control training can effectively distinguish early-stage PD patients from healthy individuals. The CPC index is significantly associated with PD severity. These findings suggest that CPC analysis has strong potential as a non-invasive, objective biomarker for early PD diagnosis.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/application-of-respiratory-controlled-cardiopulmonary-coupling-in-early-diagnosis-of-parkinsons-disease/