Tomohiko Nakamura1, Masaaki Hirayama2, Takashi Hara3, Yasuaki Mizutani4, Junichiro Suzuki4, Hirohisa Watanabe4, Gen Sobue5. 1. Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan; Department of Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan. 2. Department of Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan. 3. Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan; Department of Neurology, Chutoen General Medical Center, Shizuoka, Japan. 4. Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. 5. Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. Electronic address: sobueg@med.nagoya-u.ac.jp.
Abstract
PURPOSE: Cardiac sympathetic denervation is associated with orthostatic hypotension (OH) in Parkinson's disease (PD); however, the physiological role of cardiac sympathetic nerves has yet to be elucidated. To clarify the role of the heart in orthostatic stress, we evaluated whether cardiac sympathetic nerves can alter cardiac activity and systolic blood pressure (BP) in association with elevations or depressions of total peripheral resistance during the head-up tilt test. METHODS: Ninety-five PD patients and 17 normal controls were enrolled. Using impedance cardiography, we measured total peripheral resistance, stroke volume, heart rate, and systolic BP during the head-up tilt test. Cardiac denervation was defined as a heart-to-mediastinum ratio <1.7 for cardiac (123)I-metaiodobenzylguanidine uptake on delayed images. RESULTS: At 60° tilt, total peripheral resistance decreased from the initial value in 49 PD patients. Among these, 36 patients exhibited cardiac denervation with severe reductions in systolic BP but little change in stroke volume; among these patients 22 had OH. The remaining 13 patients without cardiac denervation exhibited significant increases in stroke volume and well-preserved systolic BP with no OH. On the other hand, 46 patients had elevations in total peripheral resistance and reduced stroke volume, but little change in systolic BP, regardless of the presence or absence of cardiac denervation. Only one of these patients experienced OH. CONCLUSION: Under orthostatic stress, cardiac sympathetic denervation with failure to increase total peripheral resistance leads to large reductions in systolic BP. However, patients without cardiac denervation exhibited a positive inotropic response against vasodilatation, which may prevent OH.
PURPOSE: Cardiac sympathetic denervation is associated with orthostatic hypotension (OH) in Parkinson's disease (PD); however, the physiological role of cardiac sympathetic nerves has yet to be elucidated. To clarify the role of the heart in orthostatic stress, we evaluated whether cardiac sympathetic nerves can alter cardiac activity and systolic blood pressure (BP) in association with elevations or depressions of total peripheral resistance during the head-up tilt test. METHODS: Ninety-five PDpatients and 17 normal controls were enrolled. Using impedance cardiography, we measured total peripheral resistance, stroke volume, heart rate, and systolic BP during the head-up tilt test. Cardiac denervation was defined as a heart-to-mediastinum ratio <1.7 for cardiac (123)I-metaiodobenzylguanidine uptake on delayed images. RESULTS: At 60° tilt, total peripheral resistance decreased from the initial value in 49 PDpatients. Among these, 36 patients exhibited cardiac denervation with severe reductions in systolic BP but little change in stroke volume; among these patients 22 had OH. The remaining 13 patients without cardiac denervation exhibited significant increases in stroke volume and well-preserved systolic BP with no OH. On the other hand, 46 patients had elevations in total peripheral resistance and reduced stroke volume, but little change in systolic BP, regardless of the presence or absence of cardiac denervation. Only one of these patients experienced OH. CONCLUSION: Under orthostatic stress, cardiac sympathetic denervation with failure to increase total peripheral resistance leads to large reductions in systolic BP. However, patients without cardiac denervation exhibited a positive inotropic response against vasodilatation, which may prevent OH.
Authors: T Pérez; B Tijero; I Gabilondo; A Luna; V Llorens; K Berganzo; M Acera; A Gonzalez; A Sanchez-Ferro; E Lezcano; J J Zarranz; J C Gómez-Esteban Journal: J Hum Hypertens Date: 2015-01-29 Impact factor: 3.012
Authors: Jeanette M Metzger; Helen N Matsoff; Alexandra D Zinnen; Rachel A Fleddermann; Viktoriya Bondarenko; Heather A Simmons; Andres Mejia; Colleen F Moore; Marina E Emborg Journal: PLoS One Date: 2020-01-07 Impact factor: 3.240
Authors: Jeanette M Metzger; Colleen F Moore; Carissa A Boettcher; Kevin G Brunner; Rachel A Fleddermann; Helen N Matsoff; Henry A Resnikoff; Viktoriya Bondarenko; Timothy J Kamp; Timothy A Hacker; Todd E Barnhart; Patrick J Lao; Bradley T Christian; R Jerry Nickles; Catherine L Gallagher; James E Holden; Marina E Emborg Journal: NPJ Parkinsons Dis Date: 2018-07-13