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Myocardial (123)I-MIBG Uptake and Cardiovascular Autonomic Function in Parkinson's Disease
Akira Katagiri1, Masato Asahina2, Nobuyuki Araki1
1Department of Neurology, Chiba University School of Medicine, Chiba 260-8670, Japan.
Abstract:
Introduction. Patients with Parkinson's disease (PD) showed reduced myocardial (123)I-MIBG uptake, which may affect autonomic regulation. We investigated correlation between MIBC accumulation and cardiovascular autonomic function in PD. Methods. We performed myocardial MIBG scintigraphy, heart rate variability (HRV) analysis, and the head-up tilt test (HUT) in 50 PD patients (66.4 ± 7.8 years; duration 5.5 ± 5.9 years). Autonomic function tests were also performed in 50 healthy controls (66.5 ± 8.9 years). As HRV parameters, a high-frequency power (HF, 0.15-0.4 Hz), a low-frequency power (LF, 0.04-0.15 Hz), and LF/HF ratio were used. Results. Our PD patients had a significant reduction in LF and HF compared with the controls (P = 0.005 and P = 0.01). In HUT, systolic and diastolic blood pressure falls in the PD group were significantly greater than those in the controls (P = 0.02 and P = 0.02). The washout rate of MIBG was negatively correlated with blood pressure changes during HUT. Conclusion. Our PD patients showed reduced HRV, blood pressure dysregulation, and reduced MIBG accumulation, which was correlated with blood pressure dysregulation. Orthostatic hypotension in PD may be mainly caused by sympathetic postganglionic degeneration.
Insights
Parkinson's disease patients exhibit reduced heart MIBG uptake and impaired autonomic function, including lower heart rate variability and blood pressure dysregulation. This MIBG reduction correlates with blood pressure changes, suggesting sympathetic nerve damage contributes to orthostatic hypotension.
Area of Science:
- Cardiology
- Neurology
- Nuclear Medicine
Background:
- Parkinson's disease (PD) is associated with reduced myocardial (123)I-MIBG uptake, potentially impacting autonomic regulation.
- Cardiovascular autonomic dysfunction is a known complication in PD patients.
Purpose of the Study:
- To investigate the correlation between myocardial (123)I-MIBG accumulation and cardiovascular autonomic function in Parkinson's disease patients.
- To assess autonomic function using heart rate variability (HRV) and head-up tilt test (HUT) in PD patients compared to healthy controls.
Main Methods:
- Myocardial MIBG scintigraphy was performed in 50 PD patients and 50 healthy controls.
- Heart rate variability (HRV) analysis, including high-frequency (HF) and low-frequency (LF) power, was conducted.
- Head-up tilt test (HUT) was used to evaluate blood pressure regulation and autonomic responses.
Main Results:
- PD patients showed significantly reduced LF and HF power in HRV compared to controls (P = 0.005 and P = 0.01).
- PD patients exhibited significantly greater blood pressure falls during HUT (P = 0.02 for both systolic and diastolic).
- The washout rate of MIBG demonstrated a negative correlation with blood pressure changes during HUT.
Conclusions:
- PD patients display diminished HRV, impaired blood pressure regulation, and reduced MIBG uptake, which correlates with autonomic dysfunction.
- Sympathetic postganglionic degeneration is likely the primary cause of orthostatic hypotension observed in Parkinson's disease.
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