Myocardial adrenergic innervation in patients with vasovagal syncope measured with 123I-MIBG uptake

Láng, István; Garai, Ildikó; Varga, Emma; Barta, K; Simko, J; Szabó, Zoltán; Galuska, László; Varga, József

doi:10.1097/mnm.0b013e328319bfcc

Cited by 7 publications

(2 citation statements)

References 17 publications

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“…123-I-MIBG scanning has previously shown higher H:M ratios in head-up tilt positive paediatric patients with vasovagal syncope [ 11 ], though an uncontrolled study in adult vasovagal patients showed more variable regional uptake deficits [ 12 ]. A more recent study in 60 patients with vasovagal syncope and 20 controls found lower H:M ratios in the vasovagal patients though with highly variable adrenergic innervation deficits in the left ventricular myocardium [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiac Iodine-123-Meta-Iodo-Benzylguanidine Uptake in Carotid Sinus Hypersensitivity

et al. 2015

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BackgroundCarotid sinus syndrome is the association of carotid sinus hypersensitivity with syncope, unexplained falls and drop attacks in generally older people. We evaluated cardiac sympathetic innervation in this disorder in individuals with carotid sinus syndrome, asymptomatic carotid sinus hypersensitivity and controls without carotid sinus hypersensitivity.MethodsConsecutive patients diagnosed with carotid sinus syndrome at a specialist falls and syncope unit were recruited. Asymptomatic carotid sinus hypersensitivity and non-carotid sinus hypersensitivity control participants recruited from a community-dwelling cohort. Cardiac sympathetic innervation was determined using Iodine-123-metaiodobenzylguanidine (123-I-MIBG) scanning. Heart to mediastinal uptake ratio (H:M) were determined for early and late uptake on planar scintigraphy at 20 minutes and 3 hours following intravenous injection of 123-I-MIBG.ResultsForty-two subjects: carotid sinus syndrome (n = 21), asymptomatic carotid sinus hypersensitivity (n = 12) and no carotid sinus hypersensitivity (n = 9) were included. Compared to the non- carotid sinus hypersensitivity control group, the carotid sinus syndrome group had significantly higher early H:M (estimated mean difference, B = 0.40; 95% confidence interval, CI = 0.13 to 0.67, p = 0.005) and late H:M (B = 0.32; 95%CI = 0.03 to 0.62, p = 0.032). There was, however, no significant difference in early H:M (p = 0.326) or late H:M (p = 0.351) between the asymptomatic carotid sinus hypersensitivity group and non- carotid sinus hypersensitivity controls.ConclusionsCardiac sympathetic neuronal activity is increased relative to age-matched controls in individuals with carotid sinus syndrome but not those with asymptomatic carotid sinus hypersensitivity. Blood pressure and heart rate measurements alone may therefore represent an over simplification in the assessment for carotid sinus syndrome and the relative increase in cardiac sympathetic innervation provides additional clues to understanding the mechanisms behind the symptomatic presentation of carotid sinus hypersensitivity.

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Section: Discussionmentioning

confidence: 99%

Cardiac Iodine-123-Meta-Iodo-Benzylguanidine Uptake in Carotid Sinus Hypersensitivity

et al. 2015

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“…Research has indicated diminished sympathetic innervation and function in patients with HUUT+. 36 In addition, there is evidence regarding the cardiac sympathetic role in myocardial contractility. 37,38 On the other hand, sympathetic nerves are involved in VVS.…”

Section: Discussionmentioning

confidence: 99%

Left atrial function evaluation by 2D speckle‐tracking echocardiography in patients with vasovagal syncope

Tajdini

Hosseinsabet

Tofighi

et al. 2023

Pacing Clinical Electrophis

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Objectives: Evidence indicates left atrial (LA) involvement in vasovagal syncope (VVS).The LA regulates left ventricular filling during the cardiac cycle. We aimed to assess LA function in patients with VVS by 2D speckle-tracking echocardiography.Methods: Sixty-nine consecutive patients with VVS were recruited. Based on the head-up tilt test (HUTT) results, the study population was divided into two groups: HUTT+ (n = 45) and HUTT− (n = 24). Fifty-one consecutive subjects were enrolled as the control group. LA myocardial deformation parameters were measured by 2D speckle-tracking echocardiography to evaluate LA function.Results: Maximal, minimal, and pre-P LA volumes were lower in patients with VVS. Strain and strain rate during reservoir, conduit, and contraction phases in VVS patients with HUTT+ or HUTT− were not statistically significantly different from those in the control group. Additionally, the volumetric parameters of LA function showed no difference in statistical significance between the three study groups.Conclusions: While LA phasic function was not different between the two groups of VVS patients with HUTT+ or HUTT− and the control group, LA size during the three LA phases was smaller in patients with VVS. K E Y W O R D Shead-up tilt test, left atrium, two-dimensional speckle-tracking echocardiography, vasovagal syncope Abbreviations: A, flow velocities of the mitral valve in late diastole; a′, velocity of mitral valve annulus at late diastole; D, flow velocities of the pulmonary vein in diastole; DT, deceleration time of the flow velocities of the mitral valve in early diastole; E, flow velocities of the mitral valve in early diastole; e′, velocity of mitral valve annulus at early diastole; HUTT, head-up tilt test; LA, left atrium; LAScd, left atrial longitudinal strain during the conduit phase; LASct, left atrial longitudinal strain during the contraction phase; LASr, left atrial longitudinal strain during the reservoir phase; LV, left ventricular; miLAV, minimal LA volume; mxLAV, maximal LA volume; pLASRcd, peak left atrial longitudinal strain rate during the conduit phase; pLASRct, peak left atrial longitudinal strain rate during the contraction phase; pLASRr, peak left atrial longitudinal strain rate during the reservoir phase; ppLAV, pre-P wave LA volume; S, flow velocities of the pulmonary vein in systole; s′, velocity of mitral valve annulus in systole; STE, speckle-tracking echocardiography; VASIS, Vasovagal Syncope International Study; VVS, vasovagal syncope.

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Dysautonomia: From the Brain Disorders to Neuropathies and Including Diabetes

Flotats

Carrió

2016

Atlas of Cardiac Innervation

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Myocardial adrenergic innervation in patients with vasovagal syncope measured with 123I-MIBG uptake

Abstract: In our patients with VVS, global I-MIBG deficit was present frequently, and all patients had regional adrenergic nerve function deficit. These alterations may play a role in causing clinical symptoms and have importance in staging and treatment planning.

Cited by 7 publications

References 17 publications

Cardiac Iodine-123-Meta-Iodo-Benzylguanidine Uptake in Carotid Sinus Hypersensitivity

Cardiac Iodine-123-Meta-Iodo-Benzylguanidine Uptake in Carotid Sinus Hypersensitivity

Left atrial function evaluation by 2D speckle‐tracking echocardiography in patients with vasovagal syncope

Dysautonomia: From the Brain Disorders to Neuropathies and Including Diabetes

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