Cardiac parasympathetic dysfunction concurrent with cardiac sympathetic denervation in Parkinson's disease.
We aimed to characterize the relationship between cardiac sympathetic and parasympathetic dysfunction employing cardiac (123)I-meta-iodobenzylguanidine (MIBG) uptake and other autonomic function parameters in Parkinson's disease (PD). 79 PD patients were studied. We performed (123)I-MIBG myocardial scintigraphy to assess the extent of cardiac sympathetic denervation. Electrocardiogram readings at rest and postural change in blood pressure were also examined. Coefficient variation of RR intervals (CVR-R) was used as an index for cardiac parasympathetic activity. Cardiac (123)I-MIBG uptake did not vary significantly among the Hoehn-Yahr (H-Y) stages. There was a significant correlation between cardiac (123)I-MIBG uptake and CVR-R (early, r=0.457, p<0.001; late, r=0.442, p<0.001). While the correlation was present among the patients who had had the disease less than two years (early, r=0.558, p<0.001; late, r=0.530, p<0.001), the patients with the disease duration longer than two years did not have such a significant correlation. Age, disease duration, corrected QT interval, or postural blood pressure change did not correlate with cardiac (123)I-MIBG uptake. Orthostatic hypotension was observed in 13 out of 72 subjects, and reduced CVR-R was a major determinant for the development of orthostatic hypotension. We conclude that cardiac parasympathetic dysfunction occurs concurrent with sympathetic denervation as revealed by (123)I-MIBG myocardial scintigraphy in PD and contributes to the development of orthostatic hypotension.
Department of Neurology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. mshibata@sc.itc.keio.ac.jp
Mamoru
M
Shibata
Yoko
Y
Morita
Toshihiko
T
Shimizu
Kazushi
K
Takahashi
Norihiro
N
Suzuki
D019797:3-Iodobenzylguanidine; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001342:Autonomic Nervous System Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D016009:Chi-Square Distribution; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000000981:diagnostic imaging / Q000209:etiology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods; D009206:Myocardium / Q000473:pathology*; D010300:Parkinson Disease / Q000150:complications* / Q000000981:diagnostic imaging; D019275:Radiopharmaceuticals; D013562:Sympathectomy
D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine