Role of cardiac sympathetic nerves in preventing orthostatic hypotension in Parkinson's disease |
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| Affiliation: | 1. Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan;2. Department of Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan;3. Department of Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan;4. Department of Neurology, Chutoen General Medical Center, Shizuoka, Japan;1. Department of Respiratory Medicine, National Hospital Organization, Omuta National Hospital, 1044-1 Tachibana, Omuta-shi, Fukuoka 837-0911, Japan;2. Research Institute for Diseases of the Chest, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan;1. Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan;2. Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan;3. Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan;1. Department of Medicine, Section of Dermatology, University of Verona, Verona, Italy;2. Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy;1. Department of Laboratory Medicine, Kurume University Hospital, Kurume, Fukuoka 830-0011, Japan;2. Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Higashimurayama, Tokyo 189-0002, Japan;3. Division of Infection Control and Prevention, Kurume University Hospital, Kurume, Fukuoka 830-0011, Japan;4. Department of Infection Control and Prevention, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan |
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| Abstract: | PurposeCardiac 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.MethodsNinety-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 123I-metaiodobenzylguanidine uptake on delayed images.ResultsAt 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.ConclusionUnder 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. |
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| Keywords: | Parkinson's disease Cardiac denervation Orthostatic hypotension Total peripheral resistance Stroke volume |
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