Rinsho Shinkeigaku (Clinical Neurology)

Original Article

Cardiac sympathetic dysfunction in Parkinson's disease -Relationship between results of 123I-MIBG scintigraphy and autonomic nervous function evaluated by the Valsalva maneuver-

Hisayoshi Oka, M.D.1), Masayuki Yoshioka, M.D.1), Masayo Morita, M.D.1), Soichiro Mochio, M.D.2) and Kiyoharu Inoue, M.D.3)

1)Aoto Hospital, Department of Neurology, Jikei University School of Medicine, 2)Third Hospital, Department of Neurology, Jikei University School of Medicine, 3)Department of Neurology, Jikei University School of Medicine

We examined whether the results of 123I-MIBG scintigraphy reflect cardiac sympathetic nerve function in patients with Parkinson's disease (PD). The subjects were 62 patients with Parkinson's disease (age, 65.4±6.3 years) and 53 controls (65.2±7.1 years). All subjects underwent 123I-MIBG scintigraphy and QTc interval measurement on ECG. Hemodynamic autonomic function was estimated by the Valsalva maneuver in 37 subjects (63.9±5.2 years) randomly selected from the patients with PD. As control, the Valsalva maneuver was also done in 20 randomly selected controls (64.1±5.0 years), and 123I-MIBG scintigraphy was performed in 21 controls (67.7±5.3 years old). The subjects rested in a supine position for 20 min and were given an intravenous injection of 111 MBq 123I-MIBG. Relative organ uptake was determined by the region of interest (ROI) in the anterior view and the ratio of average pixel count in the heart (H) to that in the mediastinum (M) was calculated (H/M ratio) for early (after 15 min) and delayed (after 3 hrs) periods. The Valsalva maneuver was done by having the subjects exhale into a mouthpiece at an expiratory pressure of 40 mmHg for 15 seconds. Blood pressure and RR intervals were measured during the Valsalva maneuver by tonometry, using a noninvasive blood pressure monitoring system (ANS 508, Nihon Colin Co., Ltd.). Baroreceptor reflex sensitivities (BRS) of the second phase (BRS II) and fourth phase (BRS IV) of the Valsalva maneuver were calculated, and blood pressure elevations during the late second phase (IIp) and fourth phase (IVp) were measured.
QTc was greater in the patients with PD (417 ms) than in the control subjects (409 ms). The H/M ratios of the early and delayed images in the patients with PD (1.76, 1.61) were significantly lower than those in the control subjects (2.56, 2.45). The early and delayed H/M ratios significantly correlated with the severity of disease according to Hoehn-Yahr stage. QTc interval and IVp significantly correlated with early and delayed H/M ratios. No other significant correlations were detected. The early H/M ratio in the patients with PD who had IVp within the normal range was lower than the early H/M ratio in control subjects.
Our results show that early and delayed H/M ratio correlates with cardiac autonomic function, evaluated on the basis of QTc interval and the Valsalva maneuver, but not with baroreceptor reflex sensitivity or vasomotor autonomic function. Our findings suggest that silent cardiac autonomic dysfunction may be evaluated by 123I-MIBG scintigraphy, because early and delayed H/M ratios were lower in the patients with PD who had normal IVp than in the control subjects.

(CLINICA NEUROL, 43: 465－469, 2003)
key words: Parkinson disease, cardiac sympathetic dysfunction, 123I-MIBG scintigraphy, Valsalva maneuver, baroreceptor function

(Received: 24-Mar-03)