title: Pattern of cardiac sympathetic denervation in idiopathic Parkinson disease studied with 11C hydroxyephedrine PET.
abstract: OBJECTIVE
  To determine whether cardiac sympathetic denervation in idiopathic Parkinson disease (IPD) affects the left ventricle in a distinct regional pattern versus a more global pattern with use of carbon 11 (11C) meta-hydroxyephedrine (HED) positron emission tomography (PET).
  
  
  METHODS
  This prospective study was approved by the institutional review board and was compliant with HIPAA. Informed consent was obtained from all subjects. Cardiac PET was performed with 11C HED in 27 patients with IPD (20 men and seven women aged 50-74 years; mean age, 62 years±6 [standard deviation]). 11C HED retention indexes (RIs), which reflect nerve density and integrity, were determined. RIs for 33 healthy control subjects (15 men and 18 women aged 20-78 years; mean age, 47 years±17) were used as a control database. Patients with IPD were compared with control subjects by using z score analysis. Global and segmental measurements of sympathetic denervation were expressed as percentage extent, z score severity, and severity-extent product (SEP). Group comparisons were performed with the Student t test.
  
  
  RESULTS
  The mean 11C HED RI was 0.086 mL of blood per minute per milliliter tissue±0.015 for control subjects and 0.043 mL of blood per minute per milliliter tissue±0.016 for patients with IPD (P<0001). When compared with normative data from the control database, profound cardiac denervation (global extent>50%) was seen in most patients (19 of 27 patients, 70%). Four patients had normal 11C HED studies and four had mild denervation (global extent<25%). The mean global denervation extent was 62%±38, the mean severity z score was -2.7±1.2, and the mean SEP was -202±131 (range, -358 to 0). Segmental analysis revealed relative sparing of anterior and proximal septal segments (mean extent, 48%-51%; mean severity z score, -2.47 to -2.0; mean SEP, -167 to -139), with lateral and proximal inferior segments more severely affected (mean extent, 68%-73%; mean severity z score, -2.8 to -2.62; mean SEP, -271 to -230). Patients with normal findings or preserved denervation did not significantly differ in mean age (t=1.09) or disease duration (t=0.44) compared to patients with severe sympathetic denervation.
  
  
  CONCLUSIONS
  Cardiac sympathetic denervation in IPD is extensive, with a segmental pattern that involves the proximal lateral left ventricular wall most severely, with relative sparing of the anterior and proximal septal walls.
authors: Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical Center, University of Michigan, 1500 E Medical Center Dr, B1G505G, Ann Arbor, MI 48105, USA. kakitw@hotmail.com
authors: Ka Kit
authors: KK
authors: Wong
authors: David M
authors: DM
authors: Raffel
authors: Robert A
authors: RA
authors: Koeppe
authors: Kirk A
authors: KA
authors: Frey
authors: Nicolaas I
authors: NI
authors: Bohnen
authors: Sid
authors: S
authors: Gilman
mesh_terms: D000368:Aged; D002250:Carbon Radioisotopes; D016022:Case-Control Studies; D003287:Contrast Media; D004809:Ephedrine / Q000031:analogs & derivatives*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000294:innervation*; D006329:Heart Conduction System / Q000000981:diagnostic imaging* / Q000473:pathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000294:innervation* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D013564:Sympathetic Nervous System / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D002250:Carbon Radioisotopes; D003287:Contrast Media; C065363:3-hydroxyephedrine; D004809:Ephedrine