Dobutamine stress test unmasks cardiac sympathetic denervation in Parkinson's disease

Nakamura, Tomohiko; Hirayama, Masaaki; Itô, Haruo; Takamori, Motoko; Hamada, Kensuke; Takeuchi, Shigeo; Watanabe, Haruo; Koike, Yasuo; Sobue, Gen

doi:10.1016/j.jns.2007.07.005

Cited by 33 publications

(28 citation statements)

References 30 publications

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“…22 In the case of PD, previous studies have reported signs of chronotropic incompetence 15 in the premotor PD and a decrease in cardiac contractibility during ergometric exercise 23 and during dobutamine stress echocardiography. 24 In the latter studies, the authors only considered as measures of cardiac contractibility the initial acceleration of blood flow in the aorta (acceleration index), and the velocity index (peak velocity of blood in the aorta). In our study, in addition to acceleration index, we measured left ventricular ejection time and LVWI, which might be more accurate measures of cardiac contractility.…”

Section: Discussionmentioning

confidence: 99%

Cardiocirculatory manifestations in Parkinson's disease patients without orthostatic hypotension

et al. 2015

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The objective of this study was to characterize cardiac sympathetic denervation in Parkinson's disease (PD) patients without neurogenic orthostatic hypotension (NOH), both in terms of hemodynamics and in its relation with vascular denervation. We studied 20 PD patients without NOH. We analyzed the heart rate and blood pressure variability during various physical maneuvers. The following parameters were calculated: expiratory-inspiratory ratio, stroke volume, cardiac output, cardiac index, left ventricular ejection time, left ventricular work index, thoracic fluid content, total peripheral resistance and baroreflex sensitivity (BRS). We also measured direct and spectral derivatives of cardiac (cardiovagal) parasympathetic function. Myocardial I-123 metaiodobenzylguanidine (MIBG) scintigraphy was performed and early and late heart/mediastinum uptake ratios were analyzed. We observed that the late heart/mediastinum uptake ratio was 1.33±0.21. This parameter was correlated with years since diagnosis (correlation coefficient:-0.485; P=0.05), Unified Parkinson's Disease Rating Scale (UPDRS) III score (cc:-0.564; P=0.02) and pressure recovery time in the Valsalva maneuver (cc: 0.61; P<0.001). At rest, it was correlated with BRS (cc:0.75; P=0.003) and low-frequency diastolic blood pressure (LFDBP; cc: 0.58;P=0.017). We found no correlations with any of the cardiography impedance variables. In linear regression models, the variable that best correlated with MIBG results was LFDBP. Our results support that in absence of NOH the degree of denervation of the heart does not produce any effect on its inotropic function. Moreover, BRS and LFDBP can be used as an indirect measure of cardiac sympathetic denervation at rest.

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Section: Discussionmentioning

confidence: 99%

Cardiocirculatory manifestations in Parkinson's disease patients without orthostatic hypotension

et al. 2015

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“…Furthermore, recent studies revealed that patients with idiopathic RBD or PD have abnormal ECG [23,24]. Nakamura et al reported that the administration of low-dose dobutamine, a beta-1 receptor agonist, revealed abnormal supersensitivity in cardiovascular responses in PD patients, although echocardiography has demonstrated normal ventricular systolic function under resting conditions [25]. In both patients, a stress test may unmask cardiac sympathetic denervation.…”

Section: Discussionmentioning

confidence: 99%

Early detection of dementia with Lewy bodies in patients with amnestic mild cognitive impairment using 123I-MIBG cardiac scintigraphy

Fujishiro¹,

Nakamura²,

Kitazawa³

et al. 2012

Journal of the Neurological Sciences

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“…The VT subsided when vasopressin was administered instead of noradrenaline. Furthermore, Nakamura et al demonstrated that administering dobutamine at a rate of 4 μg/kg/min increased both systolic pressure and cardiac contractility more in PD patients than in controls, and this hyperdynamic response was significantly correlated with reduced H/M ratios [8]. In the current case, the patient suffered from orthostatic hypotension preoperatively and exhibited severely reduced cardiac MIBG accumulation, but his denervation supersensitivity was not recognized.…”

Section: Discussionmentioning

confidence: 53%

“…More interestingly, the patient's heart rate did not change markedly after the administration of ephedrine, even though ephedrine has β-adrenergic as well as α-adrenergic effects, probably because any heart rate increase was suppressed by a reflex secondary to the rise in blood pressure. Similarly, Nakamura et al reported that dobutamine did not result in greater heart rate increases in PD patients than in controls, in spite of the fact that it caused a marked elevation of blood pressure [8].…”

Section: Discussionmentioning

confidence: 92%

Unusually large ephedrine-induced blood pressure increases due to cardiac sympathetic denervation supersensitivity in a patient with Parkinson’s disease

et al. 2018

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Background: Parkinson's disease (PD) patients often suffer from cardiac sympathetic denervation, a hallmark of which is orthostatic hypotension. Denervation supersensitivity to sympathomimetic drugs is also seen in such patients, and this phenomenon is important and can be sometimes dangerous. Case presentation: A 65-year-old male underwent gastrojejunostomy. The patient had severe PD and did not exhibit metaiodobenzylguanidine (MIBG) accumulation in his heart, which was indicative of cardiac sympathetic nerve denervation. When 8 mg of ephedrine was administered intravenously, an unexpectedly large increase in blood pressure was observed. The phenomenon recurred when 4 mg of ephedrine was administered again, and nicardipine was required to suppress the patient's blood pressure. Conclusions: Denervation supersensitivity is not as well recognized as other complications seen in PD patients, but anesthesiologists should be aware of it because sympathomimetic drugs can have excessively strong effects in patients with the condition.

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Dobutamine stress test unmasks cardiac sympathetic denervation in Parkinson's disease

Cited by 33 publications

References 30 publications

Cardiocirculatory manifestations in Parkinson's disease patients without orthostatic hypotension

Cardiocirculatory manifestations in Parkinson's disease patients without orthostatic hypotension

Early detection of dementia with Lewy bodies in patients with amnestic mild cognitive impairment using 123I-MIBG cardiac scintigraphy

Unusually large ephedrine-induced blood pressure increases due to cardiac sympathetic denervation supersensitivity in a patient with Parkinson’s disease

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