Autonomic nervous dysfunction in patients with liver cirrhosis using <sup>123</sup>I‐metaiodobenzylguanidine myocardial scintigraphy and spectrum analysis of heart‐rate variability

Iga, Akiko; Nomura, Masahiro; Sawada, Yuki; Ito, Susumu; Nakaya, Yutaka

doi:10.1046/j.1440-1746.2003.03044.x

Cited by 15 publications

(27 citation statements)

References 42 publications

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“…These results are in agreement with previous observations in similar patient populations (21,24). Several variables pertaining to a sympatho-vagal imbalance correlated significantly with H/M ratios of mIBG uptake as obtained by mIBG scintigraphy and suggest that decreased HRV is also reflected by the abnormal mIBG uptake in the heart in contrast to what has previously been reported (17). In analogy with the present findings, we and others have previously found altered response to head-up tilt in cirrhotic patients, suggesting impaired cardiovascular regulation and myocardial contractility (20,37).…”

Section: Discussionsupporting

confidence: 92%

“…In that study, the authors did not find significant changes in early and late H/M ratio but significantly higher WOR in cirrhotic patients correlating with plasma levels of noradrenaline, albumin, coagulation factor 2, 7, and 10, and Child score. The authors conclude that autonomic abnormalities even in early cirrhosis can be detected by mIBG myocardial scintigraphy (17). In our study, we extended this approach to a group of cirrhotic patients and controls well characterized with respect to hemodynamics, pulmonary function, cardiac and autonomic function, and neurohumoral abnormalities.…”

Section: Discussionmentioning

confidence: 87%

“…mIBG uptake is semiquantified by calculating the H/M ratio and WOR, which provide a highly reproducible index of cardiac sympathetic activity (8). To our knowledge, assessment of autonomic nervous function by mIBG myocardial scintigraphy in cirrhosis has only been attempted previously in one study (17). In that study, the authors did not find significant changes in early and late H/M ratio but significantly higher WOR in cirrhotic patients correlating with plasma levels of noradrenaline, albumin, coagulation factor 2, 7, and 10, and Child score.…”

Section: Discussionmentioning

confidence: 94%

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Cardiac sympathetic imaging withmIBG in cirrhosis and portal hypertension: relation to autonomic and cardiac function

Möller¹,

Mortensen

Bendtsen

et al. 2012

American Journal of Physiology-Gastrointestinal and Liver Physi

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Madsen JL. Cardiac sympathetic imaging with mIBG in cirrhosis and portal hypertension: relation to autonomic and cardiac function. Am J Physiol Gastrointest Liver Physiol 303: G1228 -G1235, 2012. First published September 27, 2012 doi:10.1152/ajpgi.00303.2012.-Autonomic and cardiac dysfunction is frequent in cirrhosis and includes increased sympathetic nervous activity, impaired heart rate variability (HRV), and baroreflex sensitivity (BRS). Quantified 123 I-metaiodobenzylguanidine (mIBG) scintigraphy reflects cardiac noradrenaline uptake, and in patients with cardiac failure it predicts outcome. In this study, we aimed to investigate cardiac sympathetic neuronal function in cirrhosis by mIBG scintigraphy in relation to cardiovascular function. Ten patients with alcoholic cirrhosis and 10 age-and sexmatched healthy controls participated in the study. Heart/mediastinum (H/M) ratios of mIBG uptake were calculated 15 and 230 min after intravenous injection of mIBG. Furthermore, washout rate (WOR) of mIBG was calculated. The patients underwent a liver vein catheterization with determination of splanchnic and systemic hemodynamics and measurement of HRV and BRS. mIBG-scintigraphy revealed significantly increased WOR in patients with cirrhosis compared with controls (P Ͻ 0.005), whereas H/M uptakes were equal in the groups. Forty percent of the patients had reduced uptake of mIBG in the infero-lateral segment of the left ventricle. WOR correlated significantly with central circulation time, an estimate of central hypovolemia (r ϭ Ϫ0.64, P Ͻ 0.05) and frequency-corrected QTF interval (r ϭ 0.71, P ϭ 0.01). Patients with cirrhosis had significantly decreased HRV and BRS correlating with indicators of abnormal cathecholamine uptake by mIBG although the catecholamine level was normal in the patients. In conclusion, in alcoholic cirrhosis, mIBG scintigraphy reveals autonomic dysfunction and impaired myocardial distribution of sympathetic nervous activity. It is associated to indicators of central hypovolemia, QT interval, and decreased HRV and BRS. Measurement of myocardial catecholamine uptake by mIBG may add important information on autonomic and cardiac dysfunction in cirrhosis. liver failure; autonomic dysfunction; single-photon emission computerized tomography; cirrhotic cardiomyopathy; baroreflex sensitivity; sympathetic nervous system; heart rate variability; chronic liver disease; hyperdynamic circulation; cirrhotic cardiomyopathy; autonomic dysfunction; 123 I-metaiodobenzylguanidine AUTONOMIC AND CARDIAC DYSFUNCTION is frequent in cirrhosis and includes impaired baroreflex sensitivity (BRS) and heart rate variability (HRV) in the setting of increased activity of the sympathetic nervous system (SNS) (10, 33, 41). The recently described, cirrhotic cardiomyopathy is seen in more than 50% of the patients and includes diastolic and systolic dysfunction as well as prolonged 43). Cirrhotic cardiomyopathy may contribute to development of complications such as renal failure and reduced survival (35). SNS is often activated...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 94%

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Cardiac sympathetic imaging withmIBG in cirrhosis and portal hypertension: relation to autonomic and cardiac function

Möller¹,

Mortensen

Bendtsen

et al. 2012

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…Mani et al [13] documented significant reduction of SDNN, LH and HF in cirrhotic subjects (n = 80) with encephalopathy compared to healthy volunteers (n = 11); significant differences were not found for LH/HF ratio. [6] reported that HRV abnormalities appear in early stages of liver cirrhosis and depend on changes of norepinephrine level. Circadian variation of HRV parameters is reported by some authors.…”

Section: Discussionmentioning

confidence: 99%

“…Haemodynamic, electric and regulatory mechanisms are affected. There is evidence on development of autonomic nervous system disorders resulting in sympathetic-parasympathetic imbalance, disturbed autoregulation of brain flow and peripheral vessel reactivity [5,6]. A non-invasive tool for evaluation of autonomic nervous system function in cardiovascular diseases is estimation of parameters of heart rate variability (HRV).…”

Section: Introductionmentioning

confidence: 99%

Heart rate variability in patients with decompensated liver cirrhosis – a pilot study

Białkowska¹,

Poliwczak²,

Jabłkowski³

et al. 2012

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Introduction: Cirrhosis is associated with many disorders of the cardiovascular system defined "cirrhotic cardiomyopathy". They concern, among others autonomic imbalance. One of the ways to evaluate these disorders is to study the heart rate variability (HRV). Abnormal HRV values occur in hypertension, ischemic heart disease, post myocardial infarction and heart failure. Are one of the prognostic factors. Aim: Evaluation of parameters of HRV in 24-hour Holter monitoring in patients with decompensated cirrhosis. Material and methods: The study included 18 patients with decompensated cirrhosis and the control group consisted of 16 healthy subjects. Enrolled were performed 24-hour Holter ECG. Heart rate variability parameters, were estimated during whole recording period, separately for night resting and morning activity hours. Results: There have been significant differences in almost all, both time and frequency HRV parameters between the two groups for follow-up clock. Similar results were obtained by comparing the HRV separately for the night and morning with a control group. The control group achieved statistically significant differences between all the time parameters of HRV at night compared with morning. Frequency parameters showed no significant differences. In patients with cirrhosis demonstrated such differences for the average time NN, SDNN, SDANN, Tr-I, Tinn and ULF. In a 24-hour observation of HRV parameters did not differ significantly depending on the grade in Child-Pugh classification. Conclusions: Patients with decompensated cirrhosis showed significantly lower HRV parameters than healthy volunteers. In addition, disturbances of circadian distribution showed

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Long-term effect of liver transplantation on cirrhotic autonomic cardiac dysfunction

Baratta

Tubani

Merli

et al. 2010

Digestive and Liver Disease

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Autonomic nervous dysfunction in patients with liver cirrhosis using ¹²³I‐metaiodobenzylguanidine myocardial scintigraphy and spectrum analysis of heart‐rate variability

Cited by 15 publications

References 42 publications

Cardiac sympathetic imaging withmIBG in cirrhosis and portal hypertension: relation to autonomic and cardiac function

Cardiac sympathetic imaging withmIBG in cirrhosis and portal hypertension: relation to autonomic and cardiac function

Heart rate variability in patients with decompensated liver cirrhosis – a pilot study

Long-term effect of liver transplantation on cirrhotic autonomic cardiac dysfunction

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Autonomic nervous dysfunction in patients with liver cirrhosis using 123I‐metaiodobenzylguanidine myocardial scintigraphy and spectrum analysis of heart‐rate variability

Cited by 15 publications

References 42 publications

Cardiac sympathetic imaging withmIBG in cirrhosis and portal hypertension: relation to autonomic and cardiac function

Cardiac sympathetic imaging withmIBG in cirrhosis and portal hypertension: relation to autonomic and cardiac function

Heart rate variability in patients with decompensated liver cirrhosis – a pilot study

Long-term effect of liver transplantation on cirrhotic autonomic cardiac dysfunction

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Autonomic nervous dysfunction in patients with liver cirrhosis using ¹²³I‐metaiodobenzylguanidine myocardial scintigraphy and spectrum analysis of heart‐rate variability