Noninvasive assessment of cardiovascular autonomic reflexes in amyotrophic lateral sclerosis: a systematic review.
Sorfina Ilham Rozman, Nur Azah Hamzaid, Einly Lim et al.
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In 30 seconds
This systematic review examined noninvasive cardiovascular signal variability measures of autonomic dysfunction in amyotrophic lateral sclerosis (ALS). From 584 records identified across four databases, 21 peer-reviewed studies met the inclusion criteria. Findings included reduced heart rate variability, impaired blood pressure regulation during orthostatic stress, circadian changes, prolonged QTc intervals and low baroreflex sensitivity. The review also describes a shift from sympathetic toward parasympathetic dysregulation as disease progresses. It highlights that commonly used ALS functional assessment does not capture autonomic features and considers the potential role of noninvasive measures in longitudinal monitoring.
Key findings
- The review included 21 peer-reviewed studies selected from 584 records identified across four databases.
- Reported cardiovascular autonomic findings included reduced heart rate variability, prolonged QTc intervals and low baroreflex sensitivity.
- Studies described absent blood pressure regulation with orthostatic stress and circadian changes.
- Increasing autonomic burden was associated with a shift from sympathetic to parasympathetic dysregulation as ALS progressed.
Why it matters
Autonomic dysfunction may contribute to cardiovascular risk and mortality in ALS, yet the ALSFRS-R focuses on functional decline and does not assess autonomic criteria. Noninvasive cardiovascular measures could help characterize this dimension of disease and support monitoring beyond motor function, although the review does not establish their clinical utility.
What to keep in mind
The review included 21 studies, and the abstract does not report pooled quantitative estimates or establish the clinical performance of the measures.