Abstract
It remains unclear whether cardiac iodine-123-labeled metaiodobenzylguanidine (123I-MIBG) uptake is clinically related to autonomic dysfunction on conventional autonomic function testing in de novo Parkinson’s disease (PD). We therefore studied the relation between cardiac 123I-MIBG uptake and cardiovascular autonomic dysfunction in patients with de novo PD. The subjects were 26 patients with de novo PD. The ratio of the average pixel count in the heart to that in the mediastinum was calculated to derive the cardiac 123I-MIBG uptake. Cardiovascular autonomic function was evaluated on the basis of cardiovascular autonomic response on the Valsalva maneuver (VM), and systolic blood pressure response (SBP) on head-up tilt-table testing (HUT). Patients with de novo PD had significantly reduced cardiac 123I-MIBG uptake as compared with controls (1.58 ± 0.43 vs. 2.25 ± 0.34, p = 0.0001) and cardiovascular autonomic response on the VM. No significant difference in the fall in SBP on HUT was found between patients with de novo PD and the controls. Cardiac 123I-MIBG uptake in de novo PD was not significantly related to vasomotor sympathetic function, baroreceptor reflex gain, cardiac parasympathetic function, or the changes in SBP on HUT. Cardiac 123I-MIBG uptake was, however, significantly related to the blood pressure overshoot in phase IV of the VM (r = 0.648, p = 0.0003). Cardiac 123I-MIBG uptake began to decrease in association with the reduction in the overshoot of phase IV on the VM. Cardiac 123I-MIBG uptake clinically reflects cardiac sympathetic dysfunction in de novo PD.
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References
Amino T, Orimo S, Ihoh Y, Takahashi A, Uchihara T, Mizusawa H (2005) Profound cardiac sympathetic denervation occurs in Parkinson disease. Brain Pathol 15:29–34
Benarroch EE, Opfer-Gehrking TL, Low PA (1991) Use of the photoplethysmographic technique to analyze the Valsalva maneuver in normal man. Muscle Nerve 14:1165–1172
Braune S, Reinhardt M, Bathmann J, Krause T, Lehmann M, Lücking CH (1998) Impaired cardiac uptake of meta-[123I]iodobenzylguanidine in Parkinson’s disease with autonomic failure. Acta Neurol Scand 97:307–314
Braune S, Reinhardt M, Schnitzer R, Riedel A, Lücking CH (1999) Cardiac uptake of [123I] MIBG separates Parkinson’s disease from multiple system atrophy. Neurology 53:1020–1025
Chung EJ, Lee WY, Yoon WT, Kim BJ, Lee HG (2009) MIBG scintigraphy for differentiating Parkinson’s disease with autonomic dysfunction from Parkinsonism-predominant multiple system atrophy. Mov Disord 24:1650–1655
Courbon F, Brefel-Courbon C et al (2003) Cardiac MIBG scintigraphy is a sensitive tool for detecting cardiac sympathetic denervation in Parkinson’s disease. Mov Disord 18:890–897
Denq JC, O’Brien PC, Low PA (1998) Normative data on phases of the Valsalva maneuver. J Clin Neurophysiol 15:535–540
Druschky A, Hilz MJ, Platsch G et al (2000) Differentiation of Parkinson’s disease and multiple system atrophy in early disease stages by means of I-123-MIBG-SPECT. J Neurol Sci 175:3–13
Gilman S (1998) Multiple system atrophy. In: Jankovic J, Tolosa E (eds) Parkinson’s disease and movement disorders, 3rd edn. Williams & Wilkins, Baltimore, pp 245–262
Goldstein DS (2003) Dysautonomia in Parkinson’s disease: neurocardiological abnormalities. Lancet Neurol 2:669–676
Haensch CA (2010) Heart trouble comes early in Parkinson’s disease before blood pressure falls. Eur J Neurol. doi:10.1111/j.1468-1331.2010.03136.x
Haensch CA, Lerch H, Jörg J, Isenmann S (2009) Cardiac denervation occurs independent of orthostatic hypotension and impaired heart rate variability in Parkinson’s disease. Parkinsonism Relat Disord 15:134–137
Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatr 55:181–184
Kirchheim HR (1976) Systemic arterial baroreceptor reflexes. Physiol Rev 56:100–177
Korner PI, Tonkin AM, Uther JB (1976) Reflex and mechanical circulatory effects of graded Valsalva maneuvers in normal man. J Appl Physiol 40:434–440
Magalhães M, Wenning GK, Daniel SE, Quinn NP (1995) Autonomic dysfunction in pathologically confirmed multiple system atrophy and idiopathic Parkinson’s disease—a retrospective comparison. Acta Neurol Scand 91:98–102
Nakamura T, Hirayama M, Ito H et al (2007) Dobutamine stress test unmasks cardiac sympathetic denervation in Parkinson’s disease. J Neurol Sci 263:133–138
Oka H, Mochio S, Inoue K (2001) Relation between autonomic dysfunction and progression of Parkinson’s disease. Rinsho Shinkeigaku 41:283–288
Oka H, Yoshioka M, Morita M, Mochio S, Inoue K (2003) Cardiac sympathetic dysfunction in Parkinson’s disease-relationship between results of 123I-MIBG scintigraphy and autonomic nervous function evaluated by the Valsalva maneuver. Rinsho Shinkeigaku 43:465–469
Oka H, Yoshioka M, Morita M, Mochio S, Inoue K (2004) 123I-meta- iodobenzylguanidine (MIBG) scintigraphy and autonomic nervous dysfunction in Parkinson’s disease and multiple system atrophy. Auton Nerv Syst 41:181–188
Oka H, Toyoda C, Yogo M, Mochio S (2010) Olfactory dysfunction and cardiovascular dysautonomia in Parkinson’s disease. J Neurol 257:969–976
Oka H, Toyoda C, Yogo M, Mochio S (2011) Cardiovascular dysautonomia in de novo Parkinson’s disease without orthostatic hypotension. Eur J Neurol 18:286–292
Orimo S, Ozawa E, Nakade S, Sugimoto T, Mizusawa H (1999) (123)I-metaiodobenzylguanidine myocardial scintigraphy in Parkinson’s disease. J Neurol Neurosurg Psychiatry 7:189–194
Orimo S, Ozawa E, Oka T et al (2001) Different histopathology accounting for a decrease in myocardial MIBG uptake in PD and MSA. Neurology 57:1140–1141
Orimo S, Oka T, Miura H et al (2002) Sympathetic cardiac denervation in Parkinson’s disease and pure autonomic failure but not in multiple system atrophy. J Neurol Neurosurg Psychiatry 73:776–777
Orimo S, Kanazawa T, Nakamura A et al (2007) Degeneration of cardiac sympathetic nerve can occur in multiple system atrophy. Acta Neuropathol 113:81–86
Orimo S, Uchihara T, Nakamura A et al (2008) Axonal alpha-synuclein aggregates herald centripetal degeneration of cardiac sympathetic nerve in Parkinson’s disease. Brain 131:642–650
Sandroni P, Ahlskog JE, Fealey RD, Low PA (1991a) Autonomic involvement in extrapyramidal and cerebellar disorders. Clin Auton Res 1:147–155
Sandroni P, Benarroch EE, Low PA (1991b) Pharmacological dissection of components of the Valsalva maneuver in adrenergic failure. J Appl Physiol 71:1563–1567
Satoh A, Serita T, Seto M et al (1999) Loss of 123I-MIBG uptake by the heart in Parkinson’s disease: assessment of cardiac sympathetic denervation and diagnostic value. J Nucl Med 40:371–375
Taki J, Nakajima K, Hwang EH et al (2000) Peripheral sympathetic dysfunction in patients with Parkinson’s disease without autonomic failure is heart selective and disease specific. Eur J Nucl Med 27:566–573
Vogel ER, Sandroni P, Low PA (2005) Blood pressure recovery from Valsalva maneuver in patients with autonomic failure. Neurology 65:1533–1537
Yoshita M (1998) Differentiation of idiopathic Parkinson’s disease from striatonigral degeneration and progressive supranuclear palsy using iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. J Neurol Sci 155:60–67
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Oka, H., Toyoda, C., Yogo, M. et al. Reduced cardiac 123I-MIBG uptake reflects cardiac sympathetic dysfunction in de novo Parkinson’s disease. J Neural Transm 118, 1323–1327 (2011). https://doi.org/10.1007/s00702-011-0598-5
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DOI: https://doi.org/10.1007/s00702-011-0598-5