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Reduced cardiac ¹²³I-MIBG uptake reflects cardiac sympathetic dysfunction in Lewy body disease

From the Department of Neurology, Jikei University School of Medicine, Tokyo, Japan.

Address correspondence and reprint requests to Dr. Hisayoshi Oka, Department of Neurology, Jikei University School of Medicine, Tokyo, 105-8461, Japan

Objective: To examine the relation between the results of cardiac ¹²³I-meta-iodobenzylguanidine (MIBG) scintigraphy and cardiovascular autonomic function in Lewy body disease (LBD).

Methods: The subjects were 66 patients with LBD, 44 of whom had Parkinson disease (PD), 10 PD with dementia (PDD), and 12 dementia with Lewy bodies (DLB); 20 age-matched healthy subjects were studied as controls. Cardiovascular autonomic function was evaluated on the basis of cardiac ¹²³I-MIBG uptake, cardiovascular autonomic response on the Valsalva maneuver (VM), and systolic blood pressure (SBP) response on head-up tilt table (HUT) testing.

Results: Patients with LBD had reduced cardiac ¹²³I-MIBG uptake, cardiovascular autonomic response on the VM, and SBP response on HUT testing as compared with controls. Cardiac ¹²³I-MIBG uptake and cardiovascular autonomic function in PDD and DLB were severely impaired as compared with those in PD. Cardiac ¹²³I-MIBG uptake in LDB was not significantly related to vasomotor sympathetic function, baroreceptor reflex gain, cardiac parasympathetic function, or the changes in SBP on HUT testing. Cardiac ¹²³I-MIBG uptake was, however, significantly related to the blood pressure overshoot in phase IV of the VM.

Conclusion: Cardiac ¹²³I-meta-iodobenzylguanidine uptake clinically reflects cardiac sympathetic dysfunction in Lewy body disease.

GLOSSARY: BRS = baroreceptor reflex sensitivity; DLB = dementia with Lewy bodies; H/M ratio = the ratio of the average pixel count in the heart to that in the mediastinum; HUT = head-up tilt table test; LBD = Lewy body disease; MIBG = ¹²³I-meta-iodobenzylguanidine; MMSE = Mini-Mental State Examination; PD = Parkinson disease; PDD = Parkinson disease with dementia; phase II E = systolic blood pressure decreases in early phase II; phase II L = systolic blood pressure increases in late phase II; PRT = pressure recovery time; VM = Valsalva maneuver; ROI = region of interest; SBP = systolic blood pressure; TH = tyrosine hydroxylase.

h.oka{at}jike.ac.jp

Disclosure: The authors report no conflicts of interest.

Received January 29, 2007. Accepted in final form April 24, 2007.

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