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. 2022 Apr;32(2):103-114.
doi: 10.1007/s10286-022-00853-6. Epub 2022 Feb 11.

Cardiac sympathetic innervation in Parkinson's disease versus multiple system atrophy

Christine Eckhardt  1 , Florian Krismer  2 , Eveline Donnemiller  3 , Sabine Eschlböck  1 , Alessandra Fanciulli  1 , Cecilia Raccagni  1   4 , Sylvia Bösch  1 , Katherina Mair  1 , Christoph Scherfler  1 , Atbin Djamshidian  1 , Christian Uprimny  3 , Bernhard Metzler  5 , Klaus Seppi  1 , Werner Poewe  1 , Stefan Kiechl  1   6 , Irene Virgolini  3 , Gregor K Wenning  7
Affiliations

Cardiac sympathetic innervation in Parkinson's disease versus multiple system atrophy

Christine Eckhardt et al. Clin Auton Res. 2022 Apr.

Abstract

Purpose: The aims of this study were to evaluate the diagnostic accuracy of the dual imaging method combining cardiac iodine-123-metaiodobenzylguanidine single-photon emission computed tomography combined with low-dose chest computed tomography compared to routine cardiac scintigraphy, and assess regional differences in tracer distribution and the relationships between imaging and autonomic function in Parkinson's disease and multiple system atrophy.

Methods: A prospective study including 19 Parkinson's disease and 12 multiple system atrophy patients was performed. Patients underwent clinical evaluation, iodine-123-metaiodobenzylguanidine single-photon emission computed tomography combined with chest computed tomography, planar scintigraphy, and cardiovascular autonomic function tests.

Results: Co-registration of single-photon emission computed tomography and chest computed tomography resulted in three groups with distinct patterns of tracer uptake: homogeneous, non-homogeneously reduced and absent. There was a significant difference in group allocation among patients with multiple system atrophy and Parkinson's disease (p = 0.001). Most multiple system atrophy patients showed homogeneous uptake, and the majority of Parkinson's disease patients showed absent cardiac tracer uptake. We identified a pattern of heterogeneous cardiac tracer uptake in both diseases with reductions in the apex and the lateral myocardial wall. Sympathetic dysfunction reflected by a missing blood pressure overshoot during Valsalva manoeuvre correlated with cardiac tracer distribution in Parkinson's disease patients (p < 0.001).

Conclusions: The diagnostic accuracy of the dual imaging method and routine cardiac scintigraphy were similar. Anatomical tracer allocation provided by the dual imaging method of cardiac iodine-123-metaiodobenzylguanidine single-photon emission computed tomography and chest computed tomography identified a heterogeneous subgroup of Parkinson's disease and multiple system atrophy patients with reduced cardiac tracer uptake in the apex and the lateral wall. Sympathetic dysfunction correlated with cardiac imaging in Parkinson's disease patients.

Keywords: Autonomic function; Cardiac sympathetic denervation; Multiple system atrophy; Parkinsonism; Parkinson’s disease.

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Conflict of interest statement

Christine Kaindlstorfer: nothing to report. Florian Krismer: reports consultancies from the Institut de Recherches Internationales Servier, Clarion Healthcare, LLC, and grants of the MSA Coalition outside the submitted work. Eveline Donnemiller: nothing to report. Sabine Eschlböck: nothing to report. Alessandra Fanciulli: reports royalties from Springer Nature Publishing Group and Thieme Verlag, speaker fees and honoraria from International Parkinson Disease and Movement Disorders Society, IOS Press, Impact Medicom, Abbvie and Theravance Biopharma, and research grants from the Stichting ParkinsonFond, MSA Coalition, Dr Johannes Tuba Stiftung and the Österreichischer Austausch Dienst, outside of the submitted work. Cecilia Raccagni: nothing to report. Sylvia Bösch: nothing to report. Katherina Mair: nothing to report. Christoph Scherfler: nothing to report. Atbin Djamshidian: nothing to report. Christian Uprimny: nothing to report. Bernhard Metzler: nothing to report. Klaus Seppi: reports personal fees from Teva, UCB, Lundbeck, AOP Orphan Pharmaceuticals AG, Roche, Grünenthal, and Abbvie; honoraria from the International Parkinson and Movement Disorders Society; research grants from the FWF Austrian Science Fund, Michael J. Fox Foundation, and International Parkinson and Movement Disorder Society, outside the submitted work. Werner Poewe: nothing to report. Stefan Kiechl: reports support from the Austrian Research Promotion Agency FFG outside the submitted work. Irene Virgolini: nothing to report. Gregor Wenning: reports consultancy and lecture fees from AbbVie, Affiris, AstraZeneca, Biogen, Lundbeck, Merz, Novartis, Ono, Teva, and Theravance, and research grants from the FWF Austrian Science Fund, the Austrian National Bank, the US MSA-Coalition, Parkinson Fonds Austria, and International Parkinson and Movement Disorder Society outside the submitted work. The authors have no conflicts of interest to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
VOIH/M of 123I-MIBG SPECT-CT of groups A, B and C are illustrated as boxplots (a). The ROC curves of VOIH/M of 123I-MIBG SPECT-CT (grey) and planar scintigraphy (black) are shown on the right side (b). a The three groups were compared using Kruskal–Wallis and appropriate post hoc test. VOIH/M differed significantly between groups A, B and C (for all group comparisons p < 0.001). b The area under the curve for the VOIH/M of 123I-MIBG SPECT-CT was 0.934; the AUC for the planar scintigraphy was 0.945 (p = 0.350). VOIH/M = heart to mediastinum ratio of the volume of interest. Group A = homogeneous, group B = non-homogeneously reduced, and group C = absent cardiac 123I-MIBG tracer uptake
Fig. 2
Fig. 2
The patterns of cardiac 123I-MIBG tracer uptake of patients 1–7 of group B are illustrated. The numbers in the images reflect the 17 cardiac territories as follows: 1: basal anterior, 2: basal anteroseptal, 3: basal inferoseptal, 4: basal inferior, 5: basal inferolateral, 6: basal anterolateral, 7: mid anterior, 8: mid anteroseptal, 9: mid inferoseptal, 10: mid inferior, 11: mid inferolateral, 12: mid anterolateral, 13: apical anterior, 14: apical septal, 15: apical inferior, 16: apical lateral, 17; apical. red = completely, orange = incompletely reduced tracer uptake. Plain spaces indicate normal tracer uptake
See this image and copyright information in PMC

Comment in

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