Objective: To evaluate the predictive value of short-term heart rate variability (HRV) parameters in assessing recurrent fall risk among patients with Multiple System Atrophy (MSA).

Background: Autonomic failure is a core clinical feature of MSA, manifesting as progressive, continuous dysautonomia. While orthostatic hypotension is a recognized contributor to postural instability, the independent predictive value of cardiac autonomic dysregulation specifically resting and standing HRV remains underexplored for identifying recurrent fallers prior to severe clinical decline.

Method: Sixty-five patients diagnosed with MSA underwent short-term HRV analysis via continuous 5-minute EKG recordings in both resting (supine) and standing states. Time-domain (RMSSD), frequency-domain (LF/HF ratio), and non-linear (DFA α1/α2) parameters were extracted. Clinical fall risk was quantified utilizing the Berg Balance Scale (BBS), Timed Up and Go test (TUG), and Tinetti Mobility Test (TMT). Disease severity was standardized using the Unified Multiple System Atrophy Rating Scale (UMSARS).

Results: The cohort was stratified into non/single fallers (42.9%) and recurrent fallers (57.1%). No significant inter-group variances were observed regarding age, sex, disease duration, or total UMSARS motor scores. However, recurrent fallers exhibited profound cardiac autonomic dysregulation, characterized by a significantly depressed resting RMSSD (p=0.020) and a pathologically elevated LF/HF ratio in both resting (p=0.011) and standing (p=0.044) states. Non-linear metrics revealed higher DFA α1 in recurrent fallers across both states (p<0.03). High BBS-stratified fall risk strongly correlated with elevated low-frequency power (p=0.01). Crucially, these HRV abnormalities predicted fall frequency independently of measurable blood pressure drops or overt orthostatic phenomena.

Conclusion: Short-term HRV analysis serves as a highly sensitive, rapid, and non-invasive biomarker for predicting fall risk in MSA. A distinct autonomic shift toward sympathetic dominance and parasympathetic withdrawal strongly correlates with recurrent falls. This cardiac metric identifies high-risk patients independently of classic orthostatic hypotension, facilitating the earlier implementation of targeted fall-prevention strategies.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/heart-rate-variability-as-an-independent-predictive-biomarker-for-fall-risk-in-multiple-system-atrophy/