Onset age and severity of motor impairment are associated with reduction of myocardial 123I-MIBG uptake in Parkinson's disease

Abstract

Objectives: To elucidate the factors associated with severity of cardiac sympathetic nerve involvement in idiopathic Parkinson's disease (PD). Methods:123 I-metaiodobenzylguanidine uptake was examined in 88 patients with PD. The ratio of the uptake in the heart (H) to that in the mediastinum (M) (the H/M ratio) was calculated and correlated with age at onset, age at examination, and disease severity and duration. Twenty five healthy people were also examined as a control.Results: There was a mild but significant negative correlation between H/M ratio and age at onset (early, r = −0.33, p = 0.002; delayed, r = −0.34, p = 0.001) and between Hoehn and Yahr (H-Y) stage (early, r = −0.30, p = 0.006; delayed, r = −0.32, p = 0.003). There was no significant correlation between disease duration and H/M ratio. When patients with PD were classified into four subgroups on the basis of age at onset (> 62 or < 62 years) and disease severity (H-Y > III or H-Y < II), the median H/M ratio of the older and more severe group was significantly lower than that of the younger and less severe group (p = 0.005). Conclusion: This study suggests that late onset, high severity PD is associated with myocardial sympathetic dysfunction.

Different patterns of cardiac sympathetic denervation in tremor-type compared to akinetic-rigid-type Parkinson’s disease: Molecular imaging with 123I-MIBG

“…This finding was more marked for the delayed compared to the early images ( Figs. 1 and 2), in agreement with several previous studies (4,7,8,(16)(17)(18)(19)(20). The use of 123 I-MIBG has been suggested as a useful marker in the diagnosis of PD (19) and as a sensitive tool in the early detection of silent autonomic dysfunction (18).…”

“…1). This finding is in agreement with other studies that reported a decrease in H/M ratio from early and delayed images in normal subjects (17,27,28). Nevertheless, several studies reported a stability or an increase in the H/M ratio over time (1,20,25).…”

“…Hamada et al suggested that a later onset of the disease rather than the length of disease duration may be associated with a lower 123 I-MIBG uptake in PD. Our results are slightly different from those of Hamada et al when considering disease duration and the number of subjects examined, and it is possible that a larger standard deviation in our data may play a role in these discrepancies (17).…”

Arachidonic acid incorporation and turnover is decreased in sympathetically denervated rat heart

“…The loss of sympathetic innervation is positively correlated with disease severity (21) and demonstrates a progressive decrease with disease progression (21,27). Although a majority of patients with Parkinson's disease have some degree of sympathetic denervation, not every patient has orthostatic hypotension; however, patients with orthostatic hypotension have a significantly greater sympathetic degree of denervation (19).…”

Differential Recovery in Cardiac and Vasomotor Sympathetic Functional Markers in a Patient with Acute Autonomic Sensory and Motor Neuropathy

“…Although the degree, timing and prognosis of sensory and motor deficits were variable in these reported cases, severe autonomic failure affecting both the sympathetic and parasympathetic functions in the initial phase of the disease was the common feature in these patients. 123 I-meta-iodobenzylguanidine ( 123 I-MIBG) myocardial scintigraphy has been used to examine the function of cardiac sympathetic nerves, particularly the postganglionic fibers (7,8). The beneficial aspects and therapeutic efficacy of 123 I-MIBG myocardial scintigraphy in assessing sympathetic dysfunction have not been described in patients with this type of neuropathy.…”