Evidence map›Paper›PMID 40696849›Full record

Observational studyAnnals of clinical and translational neurology2025

Multimodal Autonomic Biomarkers Predict Phenoconversion in Pure Autonomic Failure.

S Koay, E Vichayanrat, F Bremner, F Valerio, R Mackenzie, G Chiaro, G Ingle, P McNamara, L Watson, J N Panicker and 3 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Annals of clinical and translational neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

S KoayAutonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK.ORCID 0000-0002-0860-9211
E VichayanratAutonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK.ORCID 0000-0001-6183-0997
F BremnerDepartment of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology, London, UK.
F ValerioAutonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK.
R MackenzieAutonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK.
G ChiaroAutonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK.
G IngleAutonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK.
P McNamaraAutonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK.
L WatsonAutonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK.
J N PanickerDepartment of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology, London, UK.
M P LunnQueen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK.
C MathiasAutonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK.
V IodiceAutonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK.

Funding

Autonomic Charitable TrustGuarantors of BrainNational Brain AppealNational Institute for Health Research University College London Hospitals Biomedical Research Centre
6 · The paper itself

Abstract

backgroundPure autonomic failure (PAF) presents with autonomic failure without other neurological features. A third develop central neurological features, fulfilling criteria for multiple system atrophy (MSA) and Lewy body diseases (LBD), including Parkinson's disease and Dementia with Lewy bodies. We hypothesized multimodal autonomic biomarkers would identify differences between PAF, MSA, and LBD, and predict phenoconversion in patients presenting with PAF.

methodsThis observational cohort study included 391 alpha-synucleinopathy patients evaluated with cardiovascular autonomic testing, plasma noradrenaline, pupillometry, autonomic symptom, and quality-of-life questionnaires. PAF patients were monitored for the emergence of central neurological features. Logistic regression modeling was used to identify autonomic biomarkers at initial assessment that predicted future phenoconversion.

resultsPatients with PAF had more severe orthostatic hypotension, lower supine plasma noradrenaline, and frequent sympathetic pupillary deficits at initial assessment than MSA and LBD. 50/194 (26%) with PAF phenoconverted to MSA or LBD after a median of 13 years, with normal pupils, heart rate response to deep breathing ≥ 10 bpm, and supine plasma noradrenaline ≥ 200 pg/mL predicting future phenoconversion to MSA or LBD, with younger age at presentation and higher supine plasma noradrenaline levels associated with conversion to MSA.

conclusionIn patients presenting with PAF, normal pupillary function and supine plasma noradrenaline levels with intact cardiovagal responses were red flags for future phenoconversion. Younger patients with higher supine plasma noradrenaline levels were more likely to convert to MSA rather than LBD. A non-invasive multimodal autonomic assessment can help differentiate between alpha-synucleinopathies and predict phenoconversion from PAF to MSA or LBD.

Indexed as

Lewy Body DiseaseMultiple System AtrophyNorepinephrinePure Autonomic FailureSynucleinopathiesAgedBiomarkersCohort StudiesFemaleHumansHypotension, OrthostaticMaleMiddle AgedBiomarkersNorepinephrineautonomic failureautonomic testingmultiple system atrophyorthostatic hypotensionParkinson's diseasepure autonomic failure

Identifiers

PMID40696849
PMCPMC12623832

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.