Cardiac denervation occurs independent of orthostatic hypotension and impaired heart rate variability in Parkinson's disease

Haensch, Carl-Albrecht; Lerch, H; Jörg, Johannes; Isenmann, Stefan

doi:10.1016/j.parkreldis.2008.04.031

Cited by 101 publications

(69 citation statements)

References 20 publications

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“…Those findings describe autonomic responses, during only a limited period of time, with large individual variability, promoting a limited view of the autonomic mechanisms in control of cardiac activity [9,21,22].…”

Section: Discussionmentioning

confidence: 99%

Measures of Heart Rate Variability in Patients with Idiopathic Parkinson’s Disease

Soares¹

2013

J Alzheimers Dis Parkinsonism

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Section: Discussionmentioning

confidence: 99%

Measures of Heart Rate Variability in Patients with Idiopathic Parkinson’s Disease

Soares¹

2013

J Alzheimers Dis Parkinsonism

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“…This might indicate that generalized sympathetic denervation is more pronounced in PD ϩ OH than in PD Ϫ OH. However, denervation of sympathetic fibers to the heart has been shown to exist not only in PD ϩ OH but also in PD Ϫ OH and even in early PD (14,19). A second explanation could be the lower norepinephrine levels in PD ϩ OH.…”

Section: Discussionmentioning

confidence: 99%

Lower vascular tone and larger plasma volume in Parkinson's disease with orthostatic hypotension

Groothuis

Esselink

Seeger³

et al. 2011

Journal of Applied Physiology

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Here, we test the role of two other possible factors: 1) a reduced peripheral vasoconstriction (which may contribute because PD includes a generalized sympathetic denervation); and 2) an inadequate plasma volume (which may explain why plasma volume expansion can manage orthostatic hypotension in PD). We included 11 PD patients with orthostatic hypotension (PD ϩ OH), 14 PD patients without orthostatic hypotension (PD Ϫ OH), and 15 agematched healthy controls. Leg blood flow was examined using duplex ultrasound during 60°head-up tilt. Leg vascular resistance was calculated as the arterial-venous pressure gradient divided by blood flow. In a subset of 9 PD ϩ OH, 9 PD Ϫ OH, and 8 controls, plasma volume was determined by indicator dilution method with radiolabeled albumin ( 125 I-HSA). The basal leg vascular resistance was significantly lower in PD ϩ OH (0.7 Ϯ 0.3 mmHg·ml Ϫ1 ·min) compared with PD Ϫ OH (1.3 Ϯ 0.6 mmHg·ml Ϫ1 ·min, P Ͻ 0.01) and controls (1.3 Ϯ 0.5 mmHg·ml Ϫ1 ·min, P Ͻ 0.01). Leg vascular resistance increased significantly during 60°head-up tilt with no significant difference between the groups. Plasma volume was significantly larger in PD ϩ OH (3,869 Ϯ 265 ml) compared with PD Ϫ OH (3,123 Ϯ 377 ml, P Ͻ 0.01) and controls (3,204 Ϯ 537 ml, P Ͻ 0.01). These results indicate that PD ϩ OH have a lower basal leg vascular resistance in combination with a larger plasma volume compared with PD Ϫ OH and controls. Despite the increase in leg vascular resistance during 60°h ead-up tilt, PD ϩ OH are unable to maintain their blood pressure.Parkinson's disease; orthostatic hypotension; leg vascular resistance; plasma volume; head-up tilt SYMPTOMATIC AND ASYMPTOMATIC orthostatic hypotension (OH) is present in 30 -60% of patients with Parkinson's disease (PD) (15) and negatively correlated with quality of life (32). In elderly, OH is associated with cardiovascular morbidity and mortality (31, 33). The pathophysiology of OH in PD remains incompletely understood. Until now, the focus has been primarily on impairment of central mediated vasoconstrictor mechanisms. PD patients have a reduced baroreflex cardiovagal function, denervation of the heart, low norepinephrine levels, and no increment in norepinephrine levels during orthostatic challenges (14, 39). However, baroreflex failure and cardiac sympathetic denervation contribute to but cannot fully explain OH in PD (14, 16). During orthostatic challenges peripheral vasoconstriction contributes to maintain blood pressure via a central mediated vasoconstrictor mechanism, i.e., baroreflex, and local vasoconstrictor mechanisms, such as the venoarteriolar axon reflex (21) and the myogenic response (11). Since in PD a generalized rather than a central sympathetic denervation is present (40), central and local mediated peripheral vasoconstriction might be affected and, thereby, might play an important role in the pathophysiology of OH in PD.Furthermore, a lower plasma volume may be another contributing factor to OH in PD. This assumption is based on the important role of the s...

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“…Different groups have reported the measurement of MIBG H/M ratios by the SPECT method [29,30] . SPECT is capable of providing three-dimensional information regarding the distribution of radiopharmaceuticals in the patient's body.…”

Section: Methodsmentioning

confidence: 99%

“…However, correlations with OH and other autonomic functional tests of the cardiovascular system are not detectable [30] . Nonetheless, the study by Courbon et al [31] showed a correlation between orthostatic hypotension and autonomic cardiovascular standardized tests.…”

Section: Relationships With Other Functional Disordersmentioning

confidence: 99%

Importance of <sup>123</sup>I-Metaiodobenzylguanidine Scintigraphy/Single Photon Emission Computed Tomography for Diagnosis and Differential Diagnostics of Parkinson Syndromes

Jost

Tredici²,

Landvogt³

et al. 2010

Neurodegener Dis

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The goal of Parkinson syndrome diagnostics is twofold: early diagnosis on the one hand, and accurate differentiation among idiopathic and atypical Parkinson syndromes on the other. ¹²³I-metaiodobenzylguanidine scintigraphy is the only method that can distinguish with a high degree of sensitivity and specificity between atypical Parkinson syndromes and Parkinson’s disease or dementia with Lewy bodies. Additional advantages are the method’s widespread availability and radioactive exposure dose comparable to that for single photon emission computed tomography imaging with much lower costs. Only a single radiotracer study is necessary. ¹²³I-metaiodobenzylguanidine scintigraphy is an indispensable tool for purposes of differentiating among the various Parkinson syndromes.

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Cardiac denervation occurs independent of orthostatic hypotension and impaired heart rate variability in Parkinson's disease

Cited by 101 publications

References 20 publications

Measures of Heart Rate Variability in Patients with Idiopathic Parkinson’s Disease

Measures of Heart Rate Variability in Patients with Idiopathic Parkinson’s Disease

Lower vascular tone and larger plasma volume in Parkinson's disease with orthostatic hypotension

Importance of <sup>123</sup>I-Metaiodobenzylguanidine Scintigraphy/Single Photon Emission Computed Tomography for Diagnosis and Differential Diagnostics of Parkinson Syndromes

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