Autonomic nervous dysfunction in patients with liver cirrhosis using 123I-metaiodobenzylguanidine myocardial scintigraphy and spectrum analysis of heart-rate variability.
BACKGROUND
It has been reported that nitric oxide (NO) synthase is induced in patients with liver cirrhosis (LC), and that an excessive production of NO enhances sympathetic nervous function. The present report describes a study of the feasibility of evaluation of abnormalities of autonomic nervous function by 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy and heart-rate variability in patients with LC.


METHODS
Low-frequency (LF) power, high-frequency (HF) power, LF/HF, and 1/f fluctuations of heart rate variability were examined in 50 patients with LC (LC group), and 50 normal subjects (N group). Echocardiogram, urinary nitrite and nitrate, and cathecholamines were examined.


RESULTS
Fractional shortening was observed for the hyperdynamic state of patients in the LC group according to Child's A-C classification. Washout rate of MIBG, LF/HF, and blood levels of norepinephrine increased and HF power decreased with the progression of LC. However, the urinary secretion of nitrite and nitrate were significantly increased only in cirrhotic patients with Child C.


CONCLUSIONS
The present results indicate that autonomic abnormalities appear early in LC, and that these abnormalities can be detected by MIBG myocardial scintigraphy and analysis of heart-rate variability. We consider these methods to be clinically useful for the quantitative detection of hyperdynamic circulation of liver cirrhosis.
Iga
Akiko
A
Second Department of Internal Medicine, University of Tokushima, Tokushima, Japan.
Nomura
Masahiro
M
Sawada
Yuki
Y
Ito
Susumu
S
Nakaya
Yutaka
Y
D019797:3-Iodobenzylguanidine; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002940:Circadian Rhythm / Q000502:physiology; D004298:Dopamine / Q000097:blood; D004452:Echocardiography; D004837:Epinephrine / Q000097:blood; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007457:Iodine Radioisotopes; D008102:Liver Circulation / Q000502:physiology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D009566:Nitrates / Q000652:urine; D009638:Norepinephrine / Q000097:blood; D011516:Prothrombin / Q000378:metabolism; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012709:Serum Albumin / Q000378:metabolism; D013057:Spectrum Analysis; D013223:Statistics as Topic; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
D015415:Biomarkers; D007457:Iodine Radioisotopes; D009566:Nitrates; D019275:Radiopharmaceuticals; D012709:Serum Albumin; D019797:3-Iodobenzylguanidine; D011516:Prothrombin; D001663:Bilirubin; D004298:Dopamine; D009638:Norepinephrine; D004837:Epinephrine